Director of Clinical Impact

Remote /
Clinical & Contracting – Clinical Product /
Full-time
WithMe Health provides a medication guidance solution that replaces legacy Pharmacy Benefit Managers (PBMs) by using modern technology and rich datasets to consistently apply proven science and create individualized experiences for employees and their families. WithMe Health’s solution is unlike any other medication guidance solution in the market today: it is proactive, adaptive, convenient, and engaging. And WithMe Health’s innovative, outcomes-oriented business model aligns interests across the pharmaceutical value chain, optimizing health outcomes while substantially reducing costs for employers. The company was formed in 2018 to address the growing challenges and unmet needs that employers and employees face with legacy PBMs: misaligned business models, frustrating interactions, unknown outcomes, high costs, and a lack of real transparency. Having recently closed a $20 million round of financing from Oak HC/FT, WithMe Health is poised for significant growth while disrupting the $453 billion PBM industry and is looking to build out its team to help achieve this growth.

The Director of Clinical Impact will serve as a pharmacist subject matter expert (SME) to support and deliver WithMe’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:

Responsibilities

    • Formulary, utilization management programs and outcome measures
    • Development and implementation of clinical pathways
    • Pharmacy and Therapeutic Committee and coverage policy strategy, development, and support
    • Pharmaceutical pipeline tracking/monitoring
    • Federal and state legislation and compliance, including but not limited to Commercial/Exchange, Medicare D, Retiree Drug Subsidy Programs, and Medicaid
    • Drug program analysis and modeling, including but not limited to; trends, costs savings/ROI, benchmarking, forecasting, and other related reporting
    • Supporting RFPs for pharmacy benefit management or other services provided by vendors

Experience

    • Serve as a SME in delivering pharmacy benefit management services for WithMe’s clients across prescription and medical benefits for services described in Position Summary above.    
    • Manage and partner with WithMe’s support vendors to maintain current and custom clinical products, including formulary and utilization management programs.
    • Support product growth by developing innovative pharmacy benefit products and services.
    • Ensure products, programs and services provided are consistent with best practice approaches and in compliance with State/Federal requirements, as applicable (e.g., Formulary, Clinical programs, Medication Therapy Management, STARs, Hedis, etc.).Partner with WithMe’s Finance, Underwriting and Analytics staff to review, interpret, and provide commentary, recommendations, and forecast medication costs for WithMe clients.
    • 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 innovations to WithMe staff and downstream to clients.
    • Collaborate with the Analytics team, develop and innovate outcomes-driven medication management programs and products, present “Best in Class” solutions and clinical advisory services for WithMe clients.  
    • Provide a 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

    • Passion for improving clinical outcomes, critical thinker, willing to challenge the status quo.
    • A minimum of five (5) years experience as a pharmacy manager or minimum of two (2) years experience as a pharmacy director in a health plan(s) with direct, hands-on experience with formulary and utilization management programs (clinical review/analysis, P & T Committee support, and utilization management program development and implementation), pharmacy benefit management operations, pharmacy and medical benefit claims analysis, implementation of pharmacy program solutions, and measuring impact/performance.  
    • PharmD. required, residency and/or board certification preferred.
    • Knowledge of working within a PBM/healthcare 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 creating/developing prior authorization decision trees to support electronic PA, (such as MedHok).
    • Experience is analyzing medical benefit drugs and associated services under the medical benefit, based on HCPCS and diagnostic codes.
    • Commercial/Exchange Health Plan, Medicaid and Medicare Part D experience preferred.
    • Desire and flexibility to work as part of a clinical team and along-side other SME's at WithMe.
    • Ability to work in a fast-paced environment.
    • Desire to take ownership of pharmacist and 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 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.
    • Ability to travel.
    • Be able to work independently from home and support all time zones, regardless of where based.

Licensure

    • Must have a current and unrestricted pharmacist license in at least one state of the United States.
There are many reasons to come work for us but we’ll just list a few:

Great team. On a mission to lower medication spend with personalized guidance.  Founded on the belief that tailoring medication selection to the individual and guiding members at every step improves health outcomes and lowers the total cost of care.

      Highly competitive pay
      100% employer-paid health coverage for you; 80% employer-paid health coverage for your dependents
      401(k) plan eligible day 1
      One Medical membership
      Paid life insurance
      8 weeks’ parental leave for primary caregiver
      Flex spending
      Results-only work environment
      Generous vacation policy
 
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 legal@withmehealth.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.