Bachelor's in Pharmacy required, Pharmacy Doctorate preferred
Minimum 3 years of clinical experience
Residency or fellowship preferred, managed care experience desirable
Experience in Medication Therapy Management, Long Term Care Pharmacy consulting, or Decentralized hospital pharmacy services preferred
Responsibilities
Assist with oversight of commercial compliance workplan
Follow up on PBM claim audits and related issues
Participate in case and disease management for high drug cost patients
Educate physicians on potential improvements in drug management
Assist with Concurrent DUR, Retrospective DUR, and MTM programs
Support formulary management and identify utilization management criteria
Perform additional responsibilities as assigned
Benefits
Hybrid work model with at-home options and office locations
Enhanced professional development opportunities within pharmacy services
Exposure to a wide range of pharmacy practice areas
Collaboration with interdisciplinary teams in compliance and quality management
Engagement in quality improvement projects that impact patient outcomes
Full Job Description
The Pharmacist is responsible for providing clinical support for NHP's pharmacy, quality, compliance and health management efforts. This may include Case Management, Disease Management, Medication Therapy Management, Drug Utilization Review and creation of Clinical Programs to outcomes and cost effective drug therapy. This role assists in the development and evaluation of the plan formulary and benefit designs, and reports and presents such information as part of the NHP P&T Committee. The Pharmacist collaborates with other NHP departments to optimize regulatory compliance and Quality Measures such as NCQA HEDIS. In addition, the Pharmacist assists in outreach efforts for provider education and provider detailing.
Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required) in combination with at our office in Brookfield or Menasha, in our hybrid workplace model.
Hours: 1.0 FTE, 40 hours per week, 8am-5pm Monday through Friday
Job Responsibilities:
Assist with Commercial compliance workplan oversite
PBM follow up regarding claim audits (benefit change forms, member, reimbursement/ recoupments, follow up audits to monitor effectuation of changes)
Participate in case management, disease management and poly-pharmacy for NHP patients with extraordinary high drug costs, including related services
Assist in providing physician education in areas of potential improvement i.e., create articles for pharmacy newsletter for NHP providers, speak to medical departments regarding drug issues, speak to individual NHP providers regarding drug issues including those for individual NHP members, participate in appropriate quality improvement projects, etc.
Assist with Concurrent DUR,Retrospective DUR, and MTM programs
Assist with formulary management and identifying UM criteria
Performs other duties and responsibilities as assigned
Job Requirements:
Current Pharmacist licensure without restriction by the State of Wisconsin Pharmacy Examining Board required
Bachelor of Science in Pharmacy required, Doctor of Pharmacy preferred.
A minimum of 3 years clinical experience
Residency/fellowship preferred. Managed care experience desirable
Prefer experience in at least one of the following areas:
