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 Network Improvement Program (NIP). Assists in educating clinical pharmacist managers for the region providing information on clinical and trend issues.
Reports to: Senior Director, State Pharmacy Performance
Location: Columbia, SC
- Implements and maintains the pharmacy benefit program for the State.
- Implements and maintains the NIP program specific to pharmacy utilization.
- Reviews prescribing practices on high utilizing physicians and intervenes as needed providing drug information on pharmacy
- Collaborates with pharmacy clinical programs department to support and represent WellCare quality initiatives to providers with the market / region such as RxEffect.
- 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.
- Required A Bachelor's Degree in Pharmacy
- Preferred A Doctor of Pharmacy (PharmD)
- Required 7 years of experience in a licensed pharmacist role
- Required 3 years of management experience
- Preferred Other Experience in pharmacy operations
- Required Other Experience in managed care
Licenses and Certifications:
- 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
A license in one of the following is required:
- Required Other Licensed pharmacist in state of operation
- Required Intermediate Microsoft Excel
- Required Intermediate Microsoft Word
- Required Intermediate Microsoft Outlook
- Required Intermediate Healthcare Management Systems (Generic)