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WellCare - Pharmacy Management Careers

Senior Manager - Pharmacy Forms & Rebates Job

Full Job Title: Sr Mgr, Pharm Form & Rebates

Job Number: 1803782

Location: Tampa, FL

Date Posted: 5-29-2018

Department: Pharmacy
Reports to: Sr. Director of Pharm Form & Rebates
Location: 4110 George Road, Tampa, FL

Provides clinical and administrative pharmacy direction for the health plan through two key roles: (1) Manages the Medicaid preferred drug lists (PDLs), including operational execution throughout the health plan and (2) Manages the relationship between WellCare and the PBM's rebate team across all lines of business.

Essential Functions:

  • Develops, maintains, and reviews the Medicaid PDL's including: Therapeutic review - drug placement & utilization management, Alternatives list maintenance, and State and regulatory compliance (in conjunction with state pharmacy & medical directors)
  • Collaboration with PBM to ensure programming accuracy across all lines of business; including test claim management, Form F processing and error log management
  • As the Pharmacy SME, works in partnership with Medical Policy Committee to update and maintain applicable clinical care guidelines (CCGs) and clinical practice guidelines (CPGs)
  • Oversees and manages the relationship with the PBM's rebate team to ensure alignment between the PBM and WellCare as it relates to the selection of therapeutic classes for review and the deliverables necessary for internal rebate committee to make decisions
  • Manages the rebate committee meetings and facilitates the completion of action items, including detailed transaction log of all decisions
  • Partners with senior leadership to ensure that rebate offers are evaluated with sound and unbiased financial and clinical analysis
  • Coordinates with formulary and operations to ensure that drugs are being adjudicated according to rebate terms. Includes ensuring consistent communication of decisions and timing to all partners
  • Collaborates with the pharmacy analytics team and the actuary department to ensure successful reconciliation of rebate invoices
  • Monitors drug utilization data to identify rebating or drug utilization management opportunities, in cooperation with the drug utilization and formulary teams
  • Ensures pharmacy department meets all regulatory compliance requirements relating to rebates
  • Attends all necessary department and inter-department meetings such as Pharmacy & Therapeutics, Operations, and quarterly P&L meetings
  • Assists with audits as needed
  • Performs special projects as assigned
Candidate Education:
  • Required A Bachelor's Degree in Pharmacy
  • Preferred A Doctor of Pharmacy (PharmD)
Candidate Experience:
  • Required 5 years of experience in a licensed Pharmacist role or 3 years of experience in a licenses Pharmacist role and successful completion of a PGY-1 Residency Program
  • Required 2 years of management experience
  • Required Other experience in managed care
Candidate Skills:
  • Advanced Demonstrated interpersonal/verbal communication skills
  • Advanced Demonstrated written communication skills
  • Intermediate Ability to influence internal and external constituents
  • Intermediate Ability to communicate and make recommendations to upper management
  • Intermediate Ability to work in a fast paced environment with changing priorities
  • Intermediate Demonstrated leadership skills
  • Intermediate Other ability to use pharmaceutical and medical reference and literature to provide drug information to the health plan
  • Intermediate Other ability to evaluate information from both oral and written sources and develop clear, concise and crisp reports and recommendations
  • Intermediate Other ability to analyze and review reports
Licenses and Certifications:
A license in one of the following is required:
  • Required Other licensed Pharmacist in state of operation
  • Required Other licensed consultant in state of operation
Technical Skills:
  • Required Intermediate Microsoft Word
  • Required Intermediate Microsoft Outlook
  • Required Intermediate Microsoft Excel
  • Required Intermediate Healthcare Management Systems (Generic)

Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans to families, children, seniors and individuals with complex medical needs. WellCare is a Fortune 500 company, and in 2018, was recognized as a Fortune "World's Most Admired Company," ranking in the top five among the health insurance and managed care industry-a testament to the hard work and dedication of the company's nearly 9,000 associates who each day live WellCare's values and deliver on its mission to help its members live better, healthier lives. The company serves approximately 4.4 million members nationwide as of Dec. 31, 2017. For more information about WellCare, please visit the company's website EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, sex, age forty (40) and over, disability, veteran status, or national origin. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

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Last Updated On: 12/9/2015