About Us: We’re Wellmark’s Pharmacy Services team, and we’re accountable for oversight of all clinical and operational facets of the Wellmark pharmacy program. This includes Wellmark's Pharmacy and Therapeutics Committee, which is responsible for guiding clinical decisions which are the foundations of a diverse pharmacy product portfolio. In addition, we oversee vendors and utilization management programs in order to successfully contain rising drug costs.
About The Role: We're hiring a brand new Pharmacy Benefit Quality Specialist will serve as a key quality assurance resource in ensuring that pharmacy programming has been set-up accurately by the PBM. This individual will provide quality assurance, testing related to claim adjudication and plan set-up, and will ensure all coding has been done appropriately, while also reviewing system generated outputs to validate outcomes. Additionally, this individual will provide oversight of all PBM data interfaces, ensuring control points are in place to confirm delivery and receipt of files, accuracy for those files, and that mapping of data fields is correct.
Ideal candidates possess knowledge of pharmacy operations and UM tools, experience with reporting, data integrity, and testing, and have strong critical thinking skills. (Microsoft Excel is a must; SharePoint is a preferred.) They’re effective communicators, naturally inquisitive, and are able to build strong stakeholder relationships. Sound like a fit? Consider applying today!