We believe that Wellvana is the catalyst for systemic change that reimagines and simplifies healthcare, making it easier to practice, access, and navigate for both the patient and physician.

We do this by partnering with practices to reduce administrative complexities and costs while offering individualized data-driven patient care focused on patient health rather than reacting to illness. The result is a system that empowers physicians to do what they love, helping patients, and in turn helps people lead healthier and happier lives.

Wellvana is one of the fastest growing healthcare companies in 2022. We are founded by Martin Ventures and led by market disrupting leaders who have created and led innovative companies such as Vanguard Health, SmileDirectClub, OrNda HealthCorp, Health Trust, HCA - And we’re doing it again. But this time, you can be a part of it.

The role:

The Clinical Pharmacist - Quality Outcomes will serve as a member of the Quality Team, and will be responsible for performing and supervising pharmacy activities related to all Pharmacy Quality Initiatives. This position will oversee program staff as well as monitor and report ongoing process of Pharmacy Quality Initiatives. The Clinical Pharmacist will also perform operational maintenance and/or implementation of new clinical services as well as any additional duties deemed necessary for the Pharmacy Department.

Responsibilities:

• Perform and supervise Pharmacy activities related to all Pharmacy Quality Initiatives (i.e., Rx QI, MTMP, Adherence, Hospital Discharge Programs, Part D coverage determination and appeals processing).
• Retrieve Pharmacy reports from Health Plans portal and analyze data for distribution.
• Develop clinical pharmacy programs according to policies and regulations.
• Review patients records to determine the appropriateness of medication therapy.
• Prioritize Gap Closures for Medication Reconciliation Post Discharge, Transition of Care, FMC, COA (Medication review), by providing Member Outreach on behalf of the Provider.
• Identify untreated health problems and educate patients on topics to discuss with their physicians.
• Assess the results of pharmaceutical treatments.
• Collaborate with healthcare professionals to ensure optimal patient care.
• Keep accurate documentation of medication changes and patient progress.
• Collects, summarizes and trends provider performance data to identify and strategize opportunities for provider improvement.
• Collaborates with Provider to improve provider performance in areas of Quality (claims and encounters).
• Delivers provider specific metrics and coaches Providers on gap closing opportunities.
• Supports Provider office-based quality improvement and program studies as needed, requesting records from providers, identify missed members-provider encounter history.
• Ensures that documentation produced and/or processed complies with state regulations and/or accrediting body requirements.
• Performs other duties as assigned.

• Active, unrestricted Pharmacy license.
• 2+ years of experience as a license Pharmacist.
• Experience working with onscreen document images.
• Experience in coverage determination (prior authorization) or member appeal.
• Intermediate computer proficiency with MS Office, must have the ability to navigate a Windows base environment.

Preferred Qualifications:

• Pharmacy Residency experience.
• Proven experience as a Clinical Pharmacist.
• Experience with Commercial (private) and Medicare Part D prescription drug plans, Quality measures, programs and formularies.
• Previous experience working directly with Health Plans.
• Excellent understanding of pharmaceutical therapy and direct patient care.
• Solid knowledge of drug administration as well as health and safety guidelines.
• Skill in planning, organizing, prioritizing and delegating.
• Aptitude in exercising initiatives, judgment, problem-solving, decision-making.
• Strong professional ethics, maintaining effective relationships with medical staff.
• Skill in understanding, analyzing and developing comprehensive Part D reports.
• Ability to analyze and interpret complex data.
• Skill in developing and maintaining office-based quality improvement.
• Excellent and effective written and verbal communication skills.