Managed Care Pharmacy

[tompharm]

Can someone tell me more about managed care pharmacy. I was asked to apply to a job in managed care and I would like to know what its about and what type of medicine is involved.

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[type b pharmD]

Can someone tell me more about managed care pharmacy. I was asked to apply to a job in managed care and I would like to know what its about and what type of medicine is involved.

Well to answer your question we'd need to know more about what area of managed care you're talking about.

I would say there are 2 broad areas in managed care (some may disagree, please do so and explain)

First being a role as a sort of clinical specialist .. you manage patients medication use for the health care organization .. through visits, emails, and phone calls.. and you also serve as clinical support for providers questions about meds and therapy management .. maybe you put on a class or two for staff or patients here and there.

Second being a more desk/office oriented type job .. bread and butter of this other type of managed care job would be the insurance/formulary person.. youd help the organization keep people on formulary, approve or deny drug therapy requests, answer peoples questions about their benefits or make clinical decisions for organization regarding optimum therapies .


There are obviously overlaps.. some managed care pharmacists provide direct patient care for the majority of their job.. some work on the business side of things or work in a call center.

I can say from having a brief stint in managed care in both roles, you would be expected to be a creative thinker who can plan, start, and finish your own projects. It is usually a business office work environment. Pay is usually lower but can be higher if you are clinical or have several years of residency.

I really love managed care, but decided to turn down the offer for it due to I don't feel right working sitting down , in an office, I am not good with doing self motivated long term projects, and I'd rather have a higher energy environment to work in. My bosses in managed care made their own schedules mostly, and were salaried... a lot of weeks they would only put in 20-30 hours of work and get paid for 40 .. but during certain times of the year and near deadlines, they were easily working 60+ hour weeks in a row and not getting any extra pay. As a procrastinator and as someone who likes routine.. the position just wasn't for me.

Of course, Some pharmacists who work for managed care do regular pharmacist work.. dispensing at an outpatient pharmacy, taking calls at a pharmacy/ MTM call center, etc. These jobs are pretty cool too but usually pay less than chains, but with better benefits and more support staff. Relatively speaking, these are easier to get jobs..

Advanced clinical managed care work, such as for kaiser, requires 1-2+ years residency or fellowship. But I know for a fact that starting salary for them in my region is $140k+ .. but its not really a 40 hr per week job at all.

My manager on the insurance/formulary/benefit management side made approx $90k .. but benefits were top notch and they were more or less able to set their own schedule as long as they stayed on top of phone calls and project deadlines.


One more thing. . If you don't like meetings, avoid managed care. You will likely be expected to attend at least several boring meetings per week, potentially up to several per day.


Just my 2 cents. I am a huge econ and comparative cost efficacy nerd so I enjoyed this work setting.. but didn't want to make it my daily grind.

There are so many things to do in managed care though that I'm sure other people will have much more to add. The field is so broad, you could define it simply as working for a health care organization... so there is a lot of variety.

 

[OSU2017]

Well to answer your question we'd need to know more about what area of managed care you're talking about.

I would say there are 2 broad areas in managed care (some may disagree, please do so and explain)

First being a role as a sort of clinical specialist .. you manage patients medication use for the health care organization .. through visits, emails, and phone calls.. and you also serve as clinical support for providers questions about meds and therapy management .. maybe you put on a class or two for staff or patients here and there.

Second being a more desk/office oriented type job .. bread and butter of this other type of managed care job would be the insurance/formulary person.. youd help the organization keep people on formulary, approve or deny drug therapy requests, answer peoples questions about their benefits or make clinical decisions for organization regarding optimum therapies .


There are obviously overlaps.. some managed care pharmacists provide direct patient care for the majority of their job.. some work on the business side of things or work in a call center.

I can say from having a brief stint in managed care in both roles, you would be expected to be a creative thinker who can plan, start, and finish your own projects. It is usually a business office work environment. Pay is usually lower but can be higher if you are clinical or have several years of residency.

I really love managed care, but decided to turn down the offer for it due to I don't feel right working sitting down , in an office, I am not good with doing self motivated long term projects, and I'd rather have a higher energy environment to work in. My bosses in managed care made their own schedules mostly, and were salaried... a lot of weeks they would only put in 20-30 hours of work and get paid for 40 .. but during certain times of the year and near deadlines, they were easily working 60+ hour weeks in a row and not getting any extra pay. As a procrastinator and as someone who likes routine.. the position just wasn't for me.

Of course, Some pharmacists who work for managed care do regular pharmacist work.. dispensing at an outpatient pharmacy, taking calls at a pharmacy/ MTM call center, etc. These jobs are pretty cool too but usually pay less than chains, but with better benefits and more support staff. Relatively speaking, these are easier to get jobs..

Advanced clinical managed care work, such as for kaiser, requires 1-2+ years residency or fellowship. But I know for a fact that starting salary for them in my region is $140k+ .. but its not really a 40 hr per week job at all.

My manager on the insurance/formulary/benefit management side made approx $90k .. but benefits were top notch and they were more or less able to set their own schedule as long as they stayed on top of phone calls and project deadlines.


One more thing. . If you don't like meetings, avoid managed care. You will likely be expected to attend at least several boring meetings per week, potentially up to several per day.


Just my 2 cents. I am a huge econ and comparative cost efficacy nerd so I enjoyed this work setting.. but didn't want to make it my daily grind.

There are so many things to do in managed care though that I'm sure other people will have much more to add. The field is so broad, you could define it simply as working for a health care organization... so there is a lot of variety.

I too am curious...any other advice or eye-openers?

 

[tompharm]

Am I going to have to know anything about IVs, insulin doses, infectious diseases?
All I was told was that it was a closed door pharmacy and it was managed cared.
What you describe sounds like PBM

 

[moolman]

If it's closed door, that's not managed care. They are literally managing care, so that would be a closed door, ltc or delivery pharmacy.

The job functions described above are a MTM/amb care position and the other is a formulary team position.

There's things like clinical programs, formulary and benefits, PA, medicaid, MTM, drug utilization, outcomes analysis, list goes on and on, lots of choices and options for those that qualify.

 

[tompharm]

If it's closed door, that's not managed care. They are literally managing care, so that would be a closed door, ltc or delivery pharmacy.

The job functions described above are a MTM/amb care position and the other is a formulary team position.

There's things like clinical programs, formulary and benefits, PA, medicaid, MTM, drug utilization, outcomes analysis, list goes on and on, lots of choices and options for those that qualify.

If I was prepared to work in a retail pharmacy would I be able to work in a ltc?

 

[moolman]

Yes, if you've done retail, ltc would be fine.