Pharmacist, Director of Clinical Research
San Mateo, CA
Clinical & Contracting – Clinical Product
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 Research 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 the following pharmacy management services across prescription and medical benefits:
Pharmacy benefit management operations.
Formulary and utilization management programs.
Pharmacy and Therapeutic Committee and coverage policy strategy, development, and support.
Pharmaceutical Pipeline Tracking/MonitoringFederal 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.
Adhoc projects as assigned.
- 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 based on medical and prescription claims data 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.
- Evaluate and benchmark medication management programs and products to present “Best in Class” solutions and clinical advisory services 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.
- 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.
- Pharm.D. and/or residency certificate, 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.
Benefits: There are many reasons to come work for us but we’ll just list a few:
Highly competitive pay
80% employer-paid health coverage
401(k) plan eligible day 1
Paid life insurance
8 weeks’ parental leave for primary caregiver
Results-only work environment
Generous vacation policy
What does all that mean? It means we want you to be successful and fulfilled; to be happy and to grow. We are trying hard to be one of the best places to work and we pride ourselves on doing more for our people. We have some amazing people here and are excited to talk to you more about joining us. Are you ready?
WithMe is committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans in our job application procedures.