Why The Health Plan of West Virginia
FY2024 · Form 990Its mission and biggest programs, as filedImproves community health and well-being through technology-driven services and professional partnerships.
- The Health Plan offers a managed care program for mountain Health trust (mht), West virginia's medicaid program. At december 31, 2024, the Health plan's mht Plan serviced 100,002 members with 42,679 members enrolled from the expansion population, 41,915 members enrolled…$501M spent in FY2024
- The Health Plan offers a medicare advantage program known as secure care and a program for members eligible for both medicare and medicaid known as a medicare dual special needs Plan (dsnp). Secure care enables the medicare eligible population to…$136M spent in FY2024
- The primary exempt purpose of the Health Plan of West virgina, INC. (the Health Plan) is to operate a state certified, federally qualified Health maintenance organization (hmo) which provides comprehensive Health care services on a prepaid basis. The number of…$124.3M spent in FY2024
Before you apply
FY2024 · Form 990Independent: from IRS data, not the orgAbout the role
The org's own posting, as writtenTHIS IS NOT A REMOTE POSITION - Required to work in Wheeling - Hybrid. Responsible for comprehensive knowledge of current pharmacotherapeutic principles, disease state and population management to help ensure the delivery of safe, appropriate, and cost-efficient pharmaceutical care to membership. Required: Doctorate of Pharmacy or Bachelor of Pharmacy degree with active and unrestricted license in good standing as a registered pharmacist by a Board of Pharmacy in the U.S. prior to or within 90 days of hire date. Should have demonstrated compliance with licensure and Board of Pharmacy continuing education policy throughout hire.
Possess strong communication, complex problem solving, critical thinking, judgement and decision making and time management skills. Ability to complete accurate and detailed supporting documentation of utilization management decisions, medication reconciliations and medication reviews. Ability to work independently and carry out assignments to completion without direct supervision. Flexibility, ability to multi-task, work in a fast-paced environment, adapt to changing processes and prioritize assignments appropriately. Ability to work as a team member. Follow all plan policies and procedures.
Possess demonstrated knowledge Microsoft Office programs for business (i.e. word processing and spreadsheet applications) with proficient keyboarding and computer literacy skills and the ability to navigate multiple systems Desired: Doctorate of Pharmacy. Experience in managed care pharmacy. Pharmacy residency (managed care residency preference). Advance training (certified) in disease state management (i.e. diabetes, immunizations). Experience with government programs. Board of Pharmacy Specialties certification. Medication therapy management experience. Experience with medication reconciliation and review.
Experience participating on Interdisciplinary Care Teams in a managed care or healthcare setting.
Responsibilities
Remain continually updated regarding new products, indications, and industry trends. Develop and present new drug policies for P&T Committee review. Collaborate with The Health Plan physicians, pharmacists, nurses, and other related staff to perform utilization review of drugs for the development of drug policies including researching new drugs for possible utilization management and providing education to staff pertinent to these policies. Review drug/medical literature, clinical practice guidelines, and available national guidelines to support drug policy development and consultation over various medical and pharmacy clinical programs.
Attend CM/UM case conferences with the CM/UM nurses and Medical Directors. Provide clinical support for the administration of pharmacy benefits. Meet internal key performance indicators as defined by applicable The Health Plan Policies & Procedures. Attend on site Interdisciplinary Care Team meetings as needed for assigned/attributed members Document and complete peer-to-peer…
About The Health Plan of West Virginia
From its Form 990- Budget $772.7M
- Staff 643 · founded 1979
- Pays its leaders $241K–$691K (12 reported)
- Open jobs 19 · Jobs at The Health Plan of West Virginia · Full 990 report