Manager, Clinical Impact
San Mateo, CA /
Clinical & Contracting – Clinical Product /
Our vision is to help everyone lead their healthiest lives. And our mission is to create a significantly better medication experience for all our members, putting their health and needs first as they navigate the complexity of medications by offering our clinical expertise to them and their trusted providers to save them money and to improve their health.
We’re unsatisfied with the status quo in pharmacy benefits management and medication guidance. We know that we can provide an easier and more personalized, cost-effective, and equitable experience for members, while helping our clients--those who provide pharmacy benefits--make a more impactful investment in their members’ health.
WithMe Health is a modern pharmacy benefits manager (PBM) with a unique personalized medication guidance solution that sits on a purpose-built technology stack and offers the best PBM member mobile app experience in the market. Our pharmacist and pharmacy technician Medication Guides leverage this technology to bring their expertise and a human touch to proactively help our members.
We founded WithMe Health in 2018 to address the growing challenges and unmet needs with legacy PBMs: misaligned business models, frustrating interactions, unknown outcomes, high costs, and a lack of real transparency.
We’re growing fast. We’ve raised $48 million from Oak HC/FT, OMERS Ventures, and other leading VCs and strategic partners to take on the $450+ billion PBM industry.
The Manager, Clinical Impact will support and deliver WithMe Health’s commitments for clinical products and services to clients. This encompasses but not limited to the following pharmacy management services across prescription and medical benefits:
- Utilization management programs and outcome measures.
- Development and implementation of clinical pathways.
- Pharmacy and Therapeutic Committee and coverage policy strategy, development, and support.
- Drug program analysis and modeling, including trends, cost savings/ROI, benchmarking and forecasting
- Supporting RFPs for pharmacy benefit management or other services provided by vendors.
- Serve as a SME in delivering pharmacy benefit management services for WithMe’s clients
- Work with Director of Clinical Impact and a team of pharmacists to provide the best medication guidance experience for our members
- Manage and partner with WithMe’s support vendors to maintain current and custom clinical programs and services, including formulary and utilization management programs
- Ensure products, programs and services provided are consistent with best practice approaches and in compliance with State/Federal requirements, as applicable
- Provide pharmacy insight and knowledge of key industry trends, product pipelines, specialty medications at both pharmacy and medical benefit channels, formulary and utilization management strategies, and other pharmacy product and services innovations to WithMe clients.
- Partner with WithMe’s Finance, Underwriting and Analytics staff to review, interpret, and provide commentary, recommendations, and forecast medication costs for WithMe clients.
- Provide level of services that is appropriate for client-specific time zones and hours of operation.
- Ad hoc analyses and projects as requested by WithMe or WithMe Clients.
Qualifications and Experience
- Passion for improving clinical outcomes, critical thinker, willing to challenge the status quo.
- Ability to work in a fast-paced environment with excellent organizational and problem solving skills.
- A minimum of two (2) years experience as a manager with direct, hands-on experience with utilization management or clinical programs (clinical review/analysis, utilization management program development and implementation), implementation of pharmacy program solutions, and measuring impact/performance.
- Knowledge of working within a managed care business model, primarily around clinical programs, specialty pharmacy, and formulary/utilization management.
- Experience with Medispan nomenclature in developing and structuring coding logic necessary for implementation, maintenance, oversight and reporting of clinical service offerings (e.g., formulary, prior authorization, and step therapy).
- Experience in analyzing medical benefit drugs and associated services under the medical benefit, based on HCPCS and diagnostic codes preferred.
- Desire to take ownership of medication-related issues and drive to "Best in Class" recommendations and communications.
- Excellent written and oral presentation skills.
- Proficient in all Microsoft Office applications, especially PowerPoint, Excel, Access, and Word. Experience with SQL preferred.
- Experience in reviewing and interpreting prescription and medical claims data: Identifying trends and management opportunities, developing conclusions and actionable recommendations.
- Knowledge and experience with cost savings modeling and projections for budget impacts of formulary/utilization management changes, and rebates.
- Be able to work independently from home and support all time zones, regardless of where based.
- Pharm.D. required, residency and/or board certification preferred.
- Must have an active, current and unrestricted pharmacist license in at least one state of the United States.
- Highly competitive pay
- 100% employer-paid health coverage
- 401(k) plan eligible day 1
- Medical memberships
- Paid life insurance
- 8 weeks’ parental leave for primary caregiver
- Flex spending
- Results-only work environment
- Generous vacation policy
The US base salary range for this full-time position is $120K to $150K. Our salary ranges are determined by role, level, and location. The range displayed on each job posting reflects the minimum and maximum target for new hire salaries for the position across all US locations. Within the range, individual pay is determined by work location and additional factors, including job-related skills, experience, and relevant education or training. The hiring manager can share more about the specific salary range for your preferred location during the hiring process. Please note the compensation listed in US role postings reflect the base salary only, and do not include bonus, equity, or benefits.
WithMe Health is committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans in our job application procedures. If you need assistance or an accommodation due to a disability, you may contact us at email@example.com.
WithMe Health’s commitment to diversity and inclusion honors and respects people from different backgrounds, experiences, and perspectives both within our workforce and for the people we serve. By using a cooperative and compassionate mindset, our goal is to narrow the disparities in healthcare and to improve patient health for all people.