The posting
Company Description
Why Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputation on over 80 years’ worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors–our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today!
Learn more about our unique benefit offerings here.
Job Description
Use Your Strengths as an Associate Clinical Pharmacist at Wellmark!
In this role, you'll blend your pharmacy expertise with analytical and problem-solving skills to evaluate pharmacy opportunities focused on quality improvement, affordability, and member outcomes. This includes assisting in the development of formularies and evidence-based prior authorization criteria, performing drug utilization analyses, evaluating digital health solutions and vendor offerings, and developing tools for tracking outcomes and value associated with clinical pharmacy interventions.
You'll develop tools and materials to track outcomes, assess and communicate clinical and financial value, support evidence-based decision making, and help ensure pharmacy initiatives deliver measurable results. Collaboration is central to this position. You'll work closely with Business Analytics, Actuarial, and Health Services teams to evaluate opportunities and demonstrate their impact.
If you're passionate about leveraging both clinical expertise and analytical thinking to improve the quality, effectiveness, and value of pharmacy care, we'd love to meet you.
Hybrid environment: This position will work a hybrid schedule of at least 3 days (Tuesday, Wednesday, Thursday) in Wellmark's Des Moines office, with 2 days (Monday, Friday) remote option.
Qualifications
Required Qualifications:
-Bachelor's Degree in Pharmacy OR PharmD
-Active and unrestricted Pharmacy license in Iowa or South Dakota (individual must be licensed in the state in which they reside) is required within 6 months from date of hire.
-2+ years of strong foundational experience within retail pharmacy operations (can include internships); diversity of pharmacy work experience, including non-retail, is strongly preferred.
-Demonstrated experience making evidence-based decisions. Effective analytical, problem solving, and critical thinking skills.
-Strong written and verbal communication skills with the ability to accurately and effectively summarize clinical literature.
-Strong interpersonal skills to quickly build rapport, credibility, and collaborative partnerships with clinical peers, leaders, and stakeholders.
-Proficient in Microsoft Office & intermediate Excel skills - e.g., pivot tables, trend analysis, formulas.
-Ability to apply applicable rules, regulations, and guidelines, and maintain awareness of implications to pharmacy.
-Effective organization and prioritization skills. Ability to manage multiple projects simultaneously and consistently meet deadlines.
-Self-starter who can work well independently and as a member of a cross-functional team. Proven ability to work collaboratively with others.
Preferred Qualifications:
-Prior health plan or pharmacy benefit management experience (can include internships).
-Ability to consult with stakeholders.
Additional Information
What you will do:
a. Assists in the development and implementation of pharmacy programs to promote quality and cost effective drug use. Provides clinical consulting services to client and implements clinical information and education programs. Assist in the development of formularies and performs drug utilization analyses.
b. Responsible for assisting other Clinical Pharmacists in the management of drug utilization. Support core clinical programs such as DUR and formulary/non-formulary management. Will research and synthesize detailed clinical data related to pharmaceuticals. Prepare and present therapeutic class reviews and drug monograph information to the Pharmacy and Therapeutics Committee.
c. Assist in conducting research on medications and drug therapies. Will support Clinical Pharmacists in the development of evidence-based prior authorization criteria for pharmacy benefits. Review escalated prior authorizations and performs necessary research to determine medical necessity and appropriate coverage.
d. In collaboration with the Clinical Pharmacists, coordinate appropriate drug therapy interventions that demonstrate quality improvement, reduction in the cost of care, and improved outcomes. Actively identify and make recommendations regarding ideas to improve the quality effectiveness and efficiency of pharmacy services offered by the health plan.
e. Work collaboratively with pharmacists, pharmacy technicians and physicians to meet the goals and objectives of the pharmacy program. Direct and support internal ad hoc pharmacy management projects, as well as projects with the contracted pharmacy benefit manager, as needed.
f. Serve as a clinical resource to other physicians and nurses on areas such as prospective, concurrent and retrospective drug utilization reviews, and provide dosage conversion and clinical support for therapeutic interventions. Prepare information for network physicians. Process review prior authorization requests for non-formulary medications for clinical appropriateness.
g. Comply with regulatory standards, accreditation standards and internal guidelines, remain current and consistent with the standard pertinent to pharmaceuticals.
h. Other duties as assigned.
This job requires a non-compete agreement.
An Equal Opportunity Employer
The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.
Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at [email protected]
Please inform us if you meet the definition of a "Covered DoD official".
At this time, Wellmark is not considering applicants for this position that require any type of immigration sponsorship (additional work authorization or permanent work authorization) now or in the future to work in the United States. This includes, but IS NOT LIMITED TO: F1-OPT, F1-CPT, H-1B, TN, L-1, J-1, etc. For additional information around work authorization needs please refer to the following resources:Nonimmigrant Workers and Green Card for Employment-Based Immigrants
Wellmark supports and expects the responsible use of AI for our workforce! We welcome the responsible use of these tools by job seekers as well and are interested in learning from you; you will have an opportunity in the application process to share which tools you used and how you applied them.
