Clinical Pharmacist, Utilization Management
ABOUT THE ROLE:
Our PBM goal is to help clients better manage pharmacy spend to make drugs more affordable for their employees and dependents. Rightway is responsible for designing, building, and operating a new-to-the-world PBM model based on our core tenets: fairness & transparency, unlocking the supply chain, supporting the physician-patient relationship, and utilizing navigation to empower consumers. This role will assist UM leadership in delivering on our UM strategy and actively work UM cases.
The Clinical Pharmacist, Utilization Management is a member of the Rightway PBM Clinical Operations team. Our pharmacy benefit management (PBM) offering represents an important growth area for Rightway. Helping clients better manage pharmacy spend to make drugs more affordable for their employees and dependents is critical to their business sustainability. RightwayRx is responsible for designing, building and operating a new-to-the-world PBM model base on our core tenets: fairness & transparency, unlocking the supply chain, supporting the physician-patient relationship, and utilizing navigation to empower consumers
WHAT YOU’LL DO:
- Support all lines of business via reviewing utilization management requests for coverage that are clinically appropriate and cost effective
- Continual review of UM operational processes to ensure effective and compliant delivery of PBM services to our clients.
- Coordinate with Pharmacy technicians, Pharmacists, and/or Medical Directors on UM activities
- Ensure cases are reviewed in accordance with State and/or Federal guidelines including turnaround time requirements
- As needed, discuss clinical strategy and decision rationale with prescribers
- Participate in the quality review and inter-rater reliability processes
- Supports P&T process including the development of therapeutic class/drug monographs as needed
- Research and develop therapy-specific clinical policies and utilization management programs such as Prior Authorization, Step Therapy, Quantity Limit, and/or Coverage Determination programs
- Support Clinical Operations leadership and coordinate with Pharmacy Navigation team as needed
WHO YOU ARE:
- Education level: Pharmacy Degree Required, PharmD preferred.
- Work experience: 1 year experience coordinating medication selection with prescribers and their care teams. Preferred: 1-3+ years of managed care (PBM or health plan) prior authorization experience
- Pharmacist license in good standing in state of residence. Willingness to achieve and maintain licensure in multiple states (if needed)
- Available to work 40 hours/week. Core operating hours are weekdays within 8 am Eastern Time and 8 pm Eastern Time, but may be required to work evening and/or weekend shifts in the future as Rightway grows. On call approximately once every two months.
- Important characteristics of ideal candidate: Detail-oriented, intellectually and clinically curious, good listener, empathetic, ability to challenge status quo, values exemplar
- Specific skills needed for job: Great pharmacy benefit knowledge, effective & creative problem-solver, ability to prioritize and manage through change. Solid communication skills, ability to lead projects and influence others even without direct reporting line ownership
BASE SALARY: $120-$128K
CYBERSECURITY AWARENESS NOTICE
In response to ongoing and industry-wide fraudulent recruitment activities (i.e., job scams), Rightway wants to inform potential candidates that we will only contact them from the @rightwayhealthcare.com email domain. We will never ask for bank details or deposits of any kind as a condition of employment. If you have any questions about a suspicious interaction with Rightway, please feel free to reach out to us at firstname.lastname@example.org.
Rightway is on a mission to harmonize healthcare for everyone, everywhere. Our products guide patients to the best care and medications by inserting clinicians and pharmacists into a patient’s care journey through a modern, mobile app. Rightway is a front door to healthcare, giving patients the tools they need along with on-demand access to Rightway health guides, human experts that answer their questions and manage the frustrating parts of healthcare for them.
Since its founding in 2017, Rightway has raised over $130mm from investors including Khosla Ventures, Thrive Capital, and Tiger Global at a valuation of $1 billion. We’re headquartered in New York City, with a satellite office in Denver. Our clients rely on us to transform the healthcare experience, improve outcomes for their teams, and decrease their healthcare costs.
HOW WE LIVE OUR VALUES TO OUR TEAMMATES:
We’re seeking those with passion for healthcare and relentless devotion to our goal. We need team members who will:
- We are human first - Our humanity binds us together. We bring the same empathetic approach to every individual we engage with, whether it be our members, our clients, or each other. We are all worthy of respect and understanding and we engage in our interactions with care and intention. We honor our stories. We listen to—and hear—each other, we celebrate our differences and similarities, we are present for each other, and we strive for mutual understanding.
- We redefine what is possible - We always look beyond the obstacles in front of us to imagine new solutions. We approach our work with inspiration from other industries, other leaders, and other challenges. We use ingenuity and resourcefulness when faced with tough problems.
- We debate then commit - We believe that a spirit of open discourse is part of a healthy culture. We understand and appreciate different perspectives and we challenge our assumptions. When working toward a decision or a new solution, we actively listen to one another, approach it with a “yes, and” mentality, and assume positive intent. Once a decision is made, we align and champion it as one team.
- We cultivate grit - Changing healthcare doesn’t happen overnight. We reflect and learn from challenges and approach the future with a determination to strive for better. In the face of daunting situations, we value persistence. We embrace failure as a stepping stone to future success. On this journey, we seek to act with guts, resilience, initiative, and tenacity.
- We seek to delight - Healthcare is complicated and personal. We work tirelessly to meet the goals of our clients while also delivering the best experience to our members. We recognize that no matter the role or team, we each play a crucial part in our members’ care and take that responsibility seriously. When faced with an obstacle, we are kind, respectful, and solution-oriented in our approach. We hold ourselves accountable to our clients and our members’ success.
Rightway is a healthcare company looking to improve healthcare outcomes for everyone, everywhere. With that in mind, we have to consider what is good for the health of our team, the company, and the communities we operate in. As such, Rightway has determined a mandatory COVID-19 vaccination policy for all employees, in combination with other safety precautions, is the best way forward.
Rightway is PROUDLY an Equal Opportunity Employer that believes in strength in the diversity of thought processes, beliefs, background and education and fosters an inclusive culture where differences are celebrated to drive the best business decisions possible. We do not discriminate on any basis covered by appropriate law. All employment is decided on the consideration of merit, qualifications, need and performance.