Assistant Hedis Jobs in Appleton, WI (NOW HIRING)

The Pharmacist is responsible for providing clinical support for NHP's pharmacy, quality, compliance and health management efforts. This may include Case Management, Disease Management, Medication Therapy Management, Drug Utilization Review and creation of Clinical Programs to outcomes and cost effective drug therapy. This role assists in the development and evaluation of the plan formulary and benefit designs, and reports and presents such information as part of the NHP P&T Committee.  The Pharmacist collaborates with other NHP departments to optimize regulatory compliance and Quality Measures such as NCQA HEDIS. In addition, the Pharmacist assists in outreach efforts for provider education and provider detailing. 

Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required) in combination with at our office in Brookfield or Menasha, in our hybrid workplace model.

Hours: 1.0 FTE, 40 hours per week, 8am-5pm Monday through Friday

Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Job Responsibilities:

• Assist with Commercial compliance workplan oversite
• PBM follow up regarding claim audits (benefit change forms, member, reimbursement/ recoupments, follow up audits to monitor effectuation of changes)
• Participate in case management, disease management and poly-pharmacy for NHP patients with extraordinary high drug costs, including related services
• Assist in providing physician education in areas of potential improvement i.e., create articles for pharmacy newsletter for NHP providers, speak to medical departments regarding drug issues, speak to individual NHP providers regarding drug issues including those for individual NHP members, participate in appropriate quality improvement projects, etc.
• Assist with Concurrent DUR,Retrospective DUR, and MTM programs
• Assist with formulary management and identifying UM criteria
• Performs other duties and responsibilities as assigned

Job Requirements:

• Current Pharmacist licensure without restriction by the State of Wisconsin Pharmacy Examining Board required
• Bachelor of Science in Pharmacy required, Doctor of Pharmacy preferred.
• A minimum of 3 years clinical experience
• Residency/fellowship preferred. Managed care experience desirable
• Prefer experience in at least one of the following areas:
  • Medication Therapy Management Programs
  • Long Term Care Pharmacy consulting
  • Decentralized hospital pharmacy services

Network Health is an Equal Opportunity Employer