Clinical Pharmacist Job at Arkansas Blue Cross and Blue Shield
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Job Summary
The Clinical Pharmacist will report to and operate under the direction of Pharmacy Leadership and will also be expected to work cooperatively and sometimes independently with all medical directors and enterprise personnel.
Requirements
EDUCATION
Bachelor's degree in Pharmacy from an accredited college of pharmacy.
LICENSING/CERTIFICATION
Licensed to practice pharmacy in the State of Arkansas.
EXPERIENCE
Minimum three (3) years' pharmacy practice experience.
Minimum three (3) years' experience in managed care pharmacy c and drug utilization review preferred.
ESSENTIAL SKILLS & ABILITIES
Oral & Written Communication
Presentation
Organizational
Analytical
Problem-Solving
Decision-Making
Appeals and Exception Requests
- Majority of the pharmacist time will be spent reviewing exception requests, appeals and completing prior approvals, for all lines of commercial pharmacy business, in compliance with guidelines, quality measures and turnaround times that set forth by credentialling entities.
- Oversee and assist with the reviews completed by the PA coordinator (pharmacy technician).
- Assist with answering Medication/Formulary/Benefit related questions that are sent to the pharmacy department through Customer Service calls and managed pharmacy email.
Formulary
- Assist with development and maintenance of custom criteria on the pharmacy benefit.
- Participate in weekly PBM Clinical and Operations calls.
- Assist with notifying member of formulary changes.
- Perform drug utilization reviews in order to optimize plan design by offering a robust formulary at the lowest cost for membership.
- Make recommendations to providers for formulary options when member does not meet criteria for requested drug.
Collaborative Health Initiatives
- Work with the enterprise Collaborative Health Initiative team to develop relevant pharmacy reporting for the Collaboratives.
- Assist in presenting reports to the Collaboratives on a quarterly basis.
Other
- Serve as a resource for Enterprise Departments regarding Medication/Formulary/Benefit related questions.
- Coordinate, collaborate and assist with the other commercial benefit pharmacists.
- Assist in increasing knowledge and presence of Commercial Pharmacy Team and abilities to impact positive outcomes for our members, across the Enterprise.
Skills
Analytical, Conflict Resolution, Critical Thinking, Interpersonal skills, Leadership, Oral Communication, Problem Solving, Project Management, Task Delegation, Time Management, Written Communication
Responsibilities
Assist in development and supervise the drug utilization and prior authorization review program., Contribute to and support Enterprise-wide undertakings and commitments., Develop, implement, and manage pharmacy cost containment strategies., Develop and implement pharmacy cost containment strategies tailored to the specific situations and patterns of the enterprise, specific regions, and large accounts., Draft medical criteria and perform other activities in support of the enterprise prior authorization program., Prepare and present reports, data and analyses on the utilization and cost trends for enterprise lines of business, specific regions, and large accounts., Provide leadership and advice on developing and implementing pharmacy reimbursement, claims processing policies and procedures, and pharmacy vendor selection., Serve as a corporate pharmacy resource to medical management, operations, and sales staffs on pharmacy issues., Serve as a liaison to individual pharmacists, professional pharmacy organizations, internal committees, case management, medical management, and other providers on pharmacy issues., Work with the clinical and operations staff of all vendors of pharmacy programs to ensure that members and providers are receiving a satisfactory-level of service.
Certifications
Security Requirements
This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.
Segregation of Duties
Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.
Employment Type
Regular
ADA Requirements
1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment
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