Support pharmacy operations while helping members access safe, effective, and affordable medications.
About WellSense Health Plan
WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Medicaid, and Individual & Family plans. Founded in 1997 as Boston Medical Center HealthNet Plan, WellSense has a 25-year history of providing health plans and services that work for members, no matter their circumstances.
Schedule
- Full-time, remote work within the U.S.
- Standard weekday hours with occasional variation based on department needs
Responsibilities
- Support day-to-day operations of the pharmacy utilization management program
- Coordinate escalated inquiries from the PBM, Customer Care, Provider Services, and Care Management teams
- Assist with prior authorization reviews, formulary updates, and pharmacy benefit changes
- Respond to member, provider, and pharmacy inquiries and escalate when needed
- Process claims reject reports and monitor prescription transitions
- Provide support for pharmacy programs, including Medication Therapy Management, Drug Monitoring, and Retrospective Reviews
- Draft provider communications to ensure member access to medications
- Maintain knowledge of regulations from CMS, state agencies, and insurance divisions
- Support special projects and ad-hoc requests for the pharmacy operations team
Requirements
- High school diploma or equivalent (Associate or Bachelor’s degree preferred)
- Certified Pharmacy Technician (CPhT)
- 3+ years of professional experience, including at least 3 years in a pharmacy setting
- Prior customer service experience required
- Managed care experience in Medicaid or Medicare preferred
- Strong organizational, problem-solving, and communication skills
- Ability to multitask, maintain attention to detail, and deliver timely results
- Proficiency in data entry and computer-based systems
Benefits
- Competitive salary with opportunities for growth
- Medical, dental, vision, and prescription coverage starting Day 1
- Paid time off and holiday pay
- 401(k) retirement savings plan with company match
- Supportive, mission-driven culture with a focus on equity and inclusion
WellSense Health Plan is an equal opportunity employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability, or protected veteran status.
Happy Hunting,
~Two Chicks…