Director, State Pharmacy

This position is contingent upon the bid award in the state of North Carolina to WellCare Health Plans, Inc.1

Provides clinical pharmacy direction for the state health plans including but not limited to Medical Economics, Disease Management, Pharmacy, Utilization and Quality Management. Provides drug utilization review. Assists in development of goals and objectives for the clinical pharmacy programs within assigned market / region. Implements the requirements of the Plan's contract with the state governing agency as it pertains to prescribed drug services and other pharmacy related items for the Medicaid line of business. Assists with the development, presentation, and implementation of policies and procedures consistent with the regulatory requirements of the contract. Oversees pharmacy utilization and produces informative reports to the respective markets in each region. Works directly with the respective Medical Director of each region along with the Medical Economics department to ensure cost effective management of both medical and pharmacy utilization as part of the Provider Education Program (PEP). Assists in educating clinical pharmacist managers for the region providing information on clinical and trend issues.

Essential Functions:
  • Implements and maintains the pharmacy benefit program for the State.
  • Implements and maintains the PEP program specific to pharmacy utilization.
  • Reviews prescribing practices on high utilizing physicians and intervenes as needed providing drug information on pharmacy expenses.
  • Collaborates with pharmacy clinical programs department to support and represent WellCare quality initiatives to providers with the market / region such as RxEffect , Pharmacy Network Program (PNP).
  • Recommends changes in prescribing practices to improve quality and lower costs.
  • Provides detailed claim analysis for over and under utilization.
  • Reviews pharmacy data to look for savings opportunities.
  • Provides clinical pharmacy support for Pharmacy, Disease Management programs, Quality and Utilization Management with and emphasis on Diabetes and asthma.
  • Provides in service education to staff.
  • Provides drug utilization reviews (DUR) as needed.
  • Performs special duties as needed.
Additional Responsibilities:
    Candidate Education:
    • Required A Bachelor's Degree in Pharmacy
    • Preferred A Doctor of Pharmacy (PharmD)
    Candidate Experience:
    • Required 7 years of experience in a licensed pharmacist role
    • Preferred Other Experience in pharmacy operations
    • Required Other 3 years experience in managed care
    Candidate Skills:
    • Advanced Demonstrated interpersonal/verbal communication skills
    • Advanced Demonstrated written communication skills
    • Intermediate Other Ability to use pharmaceutical and medical reference, literature to provide drug information to the health plan
    • Intermediate Other Ability to evaluate information from both oral and written sources and develops clear, concise and crisp reports
    • Advanced Ability to influence internal and external constituents
    • Intermediate Other Ability to evaluate financially the impact of drug products
    Licenses and Certifications:
    A license in one of the following is required:
    • Required Other Licensed pharmacist in state of operation
    Technical Skills:
    • Required Intermediate Microsoft Excel
    • Required Intermediate Microsoft Word
    • Required Intermediate Microsoft Outlook
    • Required Intermediate Healthcare Management Systems (Generic)

      About us
      Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.