Provides clinical services to health plan members through collaboration with prescribers and targeted beneficiaries in order to ensure appropriate, evidence-based drug selection and resolve medication-related problems. May provide clinical services to general population or within specific therapeutic areas. Assists in the daily operational activities of clinical programs through supervision of technicians and input into program services and execution strategies. Provides support of clinical pharmacy services for the health plan as requested by serving as a resource for drug information. Essential Functions:Provides clinical services to enrolled members in assigned lines of business. May includes counseling patients and offering recommendations to physicians regarding medication-related problems. Examples clinical services include: Comprehensive Medication Reviews (CMR), targeted-medication related problem notifications, adherence programs, member and/or physician related communications (i.e. educational newsletters), drug utlilization review analysis, P&T monographs, drug information requests, prior authorization processing, particpation in appeals case review.Accurately document and records services/activities in appropriate databases/software to ensure compliance with CMS requirements for clinical service offerings assigned in designated area (i.e. Medication Therapy Management services, Quality Improvement Projects, Drug Exception Review, etc.)Supervises technicians/coordinators in regards to compliance, productivity and quality assurance goals by monitoring the daily actions of each associate to ensure that departmental policies and procedures are applied to services provided the department.Provides call center supervision including (but not limited to) decisions made by associate in regards to unit's roles and responsibilities, monitoring of inbound and outbound call volume, service level, and average call handle time (if applicable). Handles escalated member calls related to questions or concerns about drug therapy and/or clinical servicesProvides clinical pharmacy services for the health plan including, but not limited to Pharmacy Operations, Pharmacy Formulary, Pharmacy Quality and Utilization ManagementAssists in development and execution of department standard operating procedures, step action plans/workflows, training materials, and other documents as requiredProvides clinical instruction to pharmacy students/pharmacy residents as assigned to clinical areaPerforms other duties as assignedEducation LevelEducation DetailsRequired/PreferredA Bachelor's Degree in PharmacyRequiredA Doctor of Pharmacy (PharmD)PharmacyPreferredor equivalent work experiencePGY-1 Residency Program completionPreferred Work ExperienceState the minimum required for the jobExperience LevelExperience DetailsRequired/Preferred1 year of experience inDrug therapy management activitiesRequired1 year of experience inSupervision of techniciansRequired1 year of experience inExposure to managed care (student rotations acceptable).Required Licenses and CertificationsList professional licenses and certifications associated with this job Licenses/CertificationsOther Licenses/CertificationsRequired/PreferredOtherLicensed pharmacist in state of operationRequiredOtherBoard Certification (i.e. BCPS) or other designations (i.e. CGP)Preferred SkillsState the minimum required for the job Skill SetsOther SkillsProficiencyDemonstrated interpersonal/verbal communication skillsAdvancedDemonstrated written communication skillsIntermediateAbility to influence internal and external constituentsIntermediateOtherAbility to evaluate information from both oral and written sources and develops clear, concise and crisp reports.IntermediateOtherAbility to use pharmaceutical/medical literature to provide drug information to the health plan, patients, and prescribers. Intermediate TechnologyList technical skills associated with the job TechnologyOther TechnologyProficiencyRequired/PreferredMicrosoft ExcelIntermediateRequiredMicrosoft WordIntermediateRequiredMicrosoft PowerPointIntermediateRequiredMicrosoft OutlookIntermediateRequiredHealthcare Management Systems (Generic)IntermediateRequired LanguagesList all that apply LanguagesOther LanguagesRequired/PreferredSpanishPreferred
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 www.wellcare.com. 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.