Arkansas Blue Cross and Blue Shield · 1 day ago
Clinical Pharmacist
United States
Full-time
Remote
Mid Level
3+ years expArkansas Blue Cross and Blue Shield is a healthcare organization seeking a Clinical Pharmacist to support their pharmacy leadership. The role involves developing drug utilization and prior authorization programs, implementing cost containment strategies, and collaborating with medical directors to ensure optimal pharmacy practices.
Financial ServicesHealth CareNon Profit
Responsibilities
Assists in development and supervises the drug utilization and prior authorization review program
Develops and implements pharmacy cost containment strategies tailored to the specific situations and patterns of the enterprise, specific regions, and large accounts
Drafts pharmaceutical criteria and performs other activities in support of the enterprise prior authorization program
Keeps up-to-date on medication information, contributing to the identification of pharmacy program best practices, collaborating with Medical Directors, leadership, and clinical department as a subject matter expert (SME)
May be responsible for conducting the second level review for medical and pharmacy benefit medication prior-authorizations, exceptions, and medical necessity reviews submitted to the plan
May be responsible for ensuring appropriate alignment of medical policies and configuration for claims processing and utilization management
Performs other duties as assigned
Prepares and presents reports, data and analyses on the utilization and cost trends for enterprise lines of business, specific regions, and large accounts
Provides leadership and advice on developing and implementing pharmacy reimbursement, claims processing policies and procedures, and pharmacy vendor selection
Reviews and interprets coverage across assigned line(s) of business to determine what type of review is required and works with requesting providers, corporate medical directors, and other internal staff, as appropriate, in determining whether a specific case presentation meets the criteria for approval according to the specific coverage criteria
Serves as a liaison to individual pharmacists, professional pharmacy organizations, internal committees, case management, medical management, and other providers on pharmacy issues
Supports pharmacy initiatives for member, provider, and client satisfaction
Uses clinical knowledge and independent critical thinking skills towards interpreting criteria, policies, and procedures to make determinations on prior approval reviews and retrospective reviews and/or pharmacy consultations within case management
Uses knowledge of the pharmacy and/or medical benefit to communicate with, and provide recommendations to Care Management nurses, social workers, and medical directors
Uses knowledge of the pharmacy and/or medical benefit to ensure our members receive their medications in a timely fashion, avoiding delays in treatment
Qualification
Required
Bachelor's degree in Pharmacy from an accredited college of pharmacy
Holds a current, unrestricted license in pharmacy in the state(s) where job duties are performed required
Minimum three (3) years' pharmacy practice experience
Preferred
Minimum three (3) years' experience in managed pharmacy care and drug utilization review preferred
Company
Arkansas Blue Cross and Blue Shield
Arkansas Blue Cross and Blue Shield provides reliable insurance plans to Arkansans while being a valuable community partner.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Curtis Barnett
President and CEO
Recent News
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