Job Description

Company Description

Headquartered in Madison, Wisconsin, National CooperativeRx is a not-for-profit, member-owned cooperative that provides cost-effective pharmacy benefit management to self-insured employers and other purchasers of pharmacy benefits. The Cooperative leverages collective purchasing power to access the best discounts and clinical programs from a pharmacy benefit manager chosen through a competitive bid process. The focus is on high-quality services with honest, transparent pricing.

Role Description

National CooperativeRx seeks a clinical services manager to join our innovative, dynamic, nationwide organization dedicated to helping members control pharmaceutical costs. As a clinical services manager, you will utilize clinical and analytical skills to positively impact the health of members while helping reduce health care costs. This position reports to the Director of Clinical Services. This position is based in Madison, Wisconsin and one day a week in office is required.

The ideal candidate will have:

• Graduated from an accredited College or School of Pharmacy with a baccalaureate degree in pharmacy and/or a Doctor of Pharmacy degree and holds an active unrestricted pharmacy license.
• Strong analytical skills with the ability to present and defend findings.
• General but functional understanding of a pharmacy benefits manager, employer self-funding and employee benefits.
• Strong verbal and written communication skills.
• Ability to solve problems independently and as part of a team.

Duties include (but are not limited to):

• Majority of time spent reviewing prior authorizations (PA) and appeals for specialty medication prescriptions.
• Collaborate with internal and external colleagues on complex cases and conduct peer-to-peer reviews on escalated cases.
• Provide other clinical services including high dollar claims review for members of the Cooperative.
• Evaluate, recommend, and monitor PBM clinical criteria.
• Assist in the creation and implementation of new or updated Cooperative clinical programs.
• Evaluate and monitor PBM utilization reports and develop internal Cooperative reports as needed.
• Provide updates to Cooperative staff on drug utilization patterns and trends.
• Serve as a clinical resource for health plan participants, Cooperative members, and other stakeholders on clinical initiatives and issues.
• Assist with studies to evaluate clinical programs
• Assist with development of a variety of Cooperative communication materials, including marketing/educational support materials, newsletter and website content.
• Research current medical literature and other references as necessary to support Cooperative clinical programs and remain knowledgeable on clinical treatment guidelines and the drug product pipeline.

Interested candidates should send a cover letter, resume, and compensation requirements to careers@nationalcooperativerx.com.

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