Independence Blue Cross · 1 month ago
Clinical Pharmacist (PA,NJ,DE)
Philadelphia, Pennsylvania
Full-time
Hybrid
Senior Level
5+ years expIndependence Blue Cross is a healthcare organization focused on improving health outcomes. The Clinical Pharmacist is responsible for executing daily activities associated with pharmacy benefit clinical components, providing support to inter-disciplinary teams, and ensuring compliance with regulatory guidelines to enhance patient care and safety.
Health CareHealth InsuranceInsuranceMedical
Responsibilities
Ensure clinically appropriate, cost-effective, and accurate formulary by providing appropriate drug review and formulary placement recommendations
Provide support for formulary maintenance such as but not limited to member, provider, and other external communication
Collaborate with cross-functional teams for various project work
Ensure all regulatory guidelines are met
Drug Information research as needed
Serve as subject matter expert and provide recommendations designed to address Medicare Part D associated Stars ratings that may have cascading effects to other important measures such as, but not limited to, Healthcare Effectiveness Data and Information Set (HEDIS), and Consumer Assessment of Healthcare Providers and Systems (CAHPS), National Committee for Quality Assurance [NCQA] Accreditation, the Quality Rating System (Commercial Exchanges) and Health Insurance Plan Rankings
Identify underlying drivers of performance, develop and implement plans to improve ratings by working with internal departments and exploring external solutions
Present enterprise-wide ideas into structured Part D STARS meetings and recommend provider engagement strategies by supporting populating health
Oversee monthly Acumen Patient Safety reports and track performance against industry benchmarks. Identify negative trends and communicate to key stakeholders. Ensure any outlier reports are managed and submitted to Center of Medicare & Medicaid Services (CMS) within the required timelines
Review CMS opioid monitoring system (OMS) reports, Drug monitoring program (DMP) reports and internal reports. Oversee of DMP program and complete quarterly submissions for the OMS program. Coordinate activities with other departments such as Corporation Finance Investigation Department (CFID) and enrollment as needed
Provide support for marketing materials related to pharmacy quality
Serve as the subject matter expert and pharmacy liaison to the member help, population health, health coach and operations teams to facilitate the creation of job aids and training materials
Qualification
Required
Doctor of Pharmacy or Bachelor of Science Degree in Pharmacy with 5 years of relevant clinical experience
Active State Pharmacy License
At least 3 years practice managed care experience or accredited Managed Care Residency
Strategic, self starter, ambitious, proactive
Preferred
Current knowledge and expertise in clinical pharmacology, disease management and managed care
Experience with team-based care
Self-management Skills – self-motivated, organized, detail oriented and manages time and resources effectively. Must be able to work independently in a collaborative environment, be self-directed and possess excellent organizational and time management skills
Experience with STARS, Acumen and OMS submissions
Computer/Technology Competency: Proficient in use of Microsoft Word, Excel, and Outlook
Company
Independence Blue Cross
The leading health insurer in southeastern Pennsylvania. It is a sub-organization of Independence Blue Cross.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Alexandra Jorgensen
Senior Vice President Human Resources
Joe Geist
SVP & Market President, National
Recent News
Home Health Care News
2026-01-14
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