Pharmacy Account Director (Exchanges) 63911 - GI
WellPoint - United States

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WellPoint is the nations leading health benefits insurer and a Fortune Top 50 company. At WellPoint, we are dedicated to improving the lives of the people we serve and the health of our communities. WellPoint strives to simplify the connection between health, care, and value for our customers.

Bring your expertise to our innovative, achievement-driven culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine.

Responsible for managing the health plan relationship with pharmacy benefit management to ensure that PBM product design is responsive to health plan needs, meets all clinical quality standards, and can be implemented and managed in a cost effective manner. Responsibilities include, but are not limited to, maintaining health plan relationship as it pertains to pharmacy benefit management and implementation; maintain health plan-PBM relationship; ensure pharmacy benefit regulatory compliance to ensure accreditation; develop and maintain preferred drug lists (PDL) according to government regulatory compliance; develop and maintain pharmacy programs including clinical programs and edits in consideration of pharmacy data analytics, cost-effective management, and quality of care programs; collaborate with health plan in development of clinical program management and implementation; coordinate and provide key metric reporting to health plan for required reporting; membership and presentation to internal and external quality committees in support of client relationships and accreditations; triage pharmacy-related member clinical concerns for appropriate solution; provide RFP support for pharmacy benefit offerings; implement new pharmacy benefit business, including team development of business requirements, coordination with PBM, and in compliance with health plan and government requirements/ readiness review; Prepare and present all necessary materials to meet NCQA regulatory audit requirements; attend and present at health plan required meetings. Maintain active pharmacy licensure.

WellPoint is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine, one of the 100 Best Places to Work by Working Mother magazine, and is a 2011 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company please visit us at www.wellpoint.com/careers . EOE

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Job Qualifications

Requires a Registered Pharmacist (Rx). Pharm D. designation is preferred. 5 years of related experience or any combination of education and experience, which would provide an equivalent background. Maintain active pharmacy licensure.

Once an offer is accepted, all external applicants are subject to a background investigation
and if appropriate, drug testing. Offers of employment shall be contingent upon
passing both the background investigation and drug testing (if required).

  • Current WellPoint associates: All referrals must be submitted through the formal
associate referral process on WorkNet. Official guidelines for the associate referral
program can be found in My HR.

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