Pharmacy Specialist- Utilization Management

US-IA-Des Moines
Job ID
Clinical/Provider Support
Requires Non-Compete?

Job Summary

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 Specialist – Utilization Management (UM). This individual will be responsible for the daily, weekly, monthly, and periodic administrative functions necessary to update and maintain the UM programs for Wellmark’s line of business. This includes working with the Sr. Clinical Pharmacist – UM and PBM to make updates to UM criteria sets, identify affected members and providers, analyze decisions, and develop reports for leadership to demonstrate the effectiveness of the program.


Ideal candidates possess related pharmacy operations work experience, effective critical thinking and communication skills, and are proficient with Microsoft Excel. They’re naturally inquisitive, would enjoy the opportunity to develop a deep understanding of Wellmark's pharmacy operations, and are self-starters able to flex with changing priorities. Sound like a fit? Consider applying today!


Minimum Qualifications Required (all must be met to be considered)

  • HS diploma or GED.
  • 1+ year of related pharmacy operations work experience from within managed care, health care, pharmacy, PBM, or similar environment. Experience should reflect knowledge of pharmacy practice (e.g., drug name, NDC, GPI), pharmacy claims processing and/or UM tools (e.g., formulary, prior authorization, step therapy).
  • Effective critical thinking and analysis skills. Ability to evaluate information and implement appropriate solutions.
  • Strong written and verbal communications skills with the ability to clearly and concisely communicate complex concepts with internal and external stakeholders.
  • Strong interpersonal skills with the ability to build relationships of collaboration and trust with different business areas. Viewed as a subject matter expert and go-to resource.
  • Proficiency with Microsoft Office, including Excel; use of pivot tables, charts, and formulas is preferred. Technical aptitude to learn new software quickly.
  • Self-starter with strong organizational skills and the ability to independently balance priorities in a fast-paced, dynamic environment. Flexible and adaptable to change.

Hiring Specifications Preferred

  • Associate’s Degree.
  • Certified Pharmacy Technician.

Job Accountabilities

a. Develop and maintain code sets for all therapeutic classes with UM programs, including supporting electronic prior authorization programs.

b. Maintain the policies and procedures for all activities related to the UM program. Including the internal and external communication materials.

c. Coordinate with internal and/or external cross-functional teams (e.g., medical management, sales, PBM, pharmacy services) regarding the implementation and maintenance of utilization management programs. Compile dashboards and reports to conduct analysis to determine impact of new and existing UM programs and accreditation activities.

d. Knowledgeable of applicable regulatory standards, accreditation standards and internal guidelines (e.g., NCQA or UM standards); remain current and consistent with the standard pertinent to pharmaceuticals.

e. Other duties as assigned.


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