Managed Care Pharmacist

At WelbeHealth, we serve our communities’ most vulnerable seniors through shared intention, pioneering spirit, and the courage to love. These core values and our participant-focus lead the way no matter what.

Under the direction of the Pharmacy and Medical Practice leadership, the Managed Care Pharmacist is accountable for ensuring compliance with Medicare, Medicaid, and PACE regulations. This role partners with other teams on pharmacy-related initiatives and assists with day-to-day management of our PBM and contracted pharmacy.

This role is different because the Managed Care Pharmacist at WelbeHealth:

• Collaborates closely with interdisciplinary care teams to optimize medication outcomes for frail, vulnerable seniors - not just managing utilization or compliance like in traditional managed care settings
• Works with a hands-on, holistic approach – this role extends beyond regulatory oversight to include direct involvement in quality improvement, medication safety, and clinical leadership within a fully integrated care delivery model

We care about our team members. That’s why we offer:

• Medical insurance coverage (Medical, Dental, Vision)
• Work/life balance - We mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days
• 401K savings + match
• Comprehensive compensation package including base pay, bonus, and equity
• And additional benefits!

On the day-to-day, you will:

• Ensure compliance with regulatory requirements including Medicare Part D regulations, PACE standards, and state pharmacy regulations
• Participate in quality improvement initiatives aimed at enhancing medication-related outcomes and reducing healthcare costs
• Monitor and analyze provider and participant drug utilization patterns to produce utilization and clinical quality reports
• Review and complete reporting related to Part D compliance such as FWA or B/D determinations
• Implement strategies to mitigate medication-related risks including adverse drug reactions, falls, and medication errors
• Oversee clinic medication room including automated dispensing machine, floor stock, vaccines, and inventory maintenance
• Partner with pharmacy for STAT medication fulfillment, processing concerns, and administrative needs

Job requirements include:

• Doctor of Pharmacy (PharmD) degree from an accredited pharmacy program; active and unrestricted license in the state of practice
• Clinical pharmacy residency or fellowship training, especially in geriatrics or ambulatory care preferred
• Minimum of three (3) years of experience as a clinical pharmacist, preferably in managed care, geriatrics, or ambulatory care
• Experience in managed care, health plans, PBMs, and Part D required
• Strong clinical knowledge and proficiency in pharmacotherapy, drug interactions, and medication reconciliation
• Proficiency with Microsoft Office Suite, particularly Excel and PowerPoint
• Excellent communication and interpersonal skills, with the ability to collaborate effectively within a multidisciplinary team

We are seeking a Managed Care Pharmacist that ideally has clinical pharmacy experience and familiarity with geriatrics, managed care, or ambulatory care. If you’re ready to join a holistic care team that values both its participants and providers, we’d love to hear from you!