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Meridian

    Manager Clinical Pharmacy - Meridian, United States - Blue Cross and Blue Shield Association

    Blue Cross and Blue Shield Association
    Blue Cross and Blue Shield Association Meridian, United States

    2 weeks ago

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    Description

    Our Manager Clinical Pharmacist will handle ongoing, day-to-day management of the clinical pharmacy programs, including formulary management, development of pharmacy review policies, making recommendations to the Pharmacy and Therapeutics Committee from Medi-span review and other information available, performing rebate evaluation, administering or developing generic utilization programs, and resolving escalated pharmacy-related issues for members, providers, and purchasers.

    Consult on drug therapies with medical staff and suggest alternatives as appropriate. Collaborate with and support physician and physician groups including academic detailing and financial risk management related to prescribing. Develop and/or maintain utilization and productivity reporting for the department. Stay abreast of pharmacy, PBM, and payer industry changes. Serve as the primary pharmacy representative to Medical Management and the Blue Cross of Idaho Pharmacy & Therapeutics committee.

    This role will have direct reports including individual contributors and managers.

    One of the managers is responsible over the utilization management team and the other manager is responsible with PBM utilization management oversight in addition to medical UM reviews and supporting other duties as assigned.

    This role is responsible for the performance of medication coverage of the pharmacy benefit and medical benefit including but not limited to utilization management, formulary management, medical benefit drug coverage, and clinical PBM oversight.


    We're looking for Manager Clinical Pharmacist with:

    • Experience: 7 years' health industry or related field experience, with marketing, finance, product strategy and field experience, with marketing, finance, product strategy and/or managed care responsibility to include leadership
    • Education: Degree in pharmacy (RPh or PharmD)
    • Licenses/Certifications: Current active license to practice pharmacy in the U.S. and must obtain Idaho licensure within 120 days of hire
    What a day of a Manager Clinical Pharmacist would look like:


    • Provide day-to-day management of BCI's Clinical Pharmacy team. Handle issues that are raised by the team and work to prevent issues from reoccurring through re-design or standardizing processes.
    • Develop or maintain operational reports that quantify and enable management of productivity, quality, and customer satisfaction.
    • Manage, with the PBM, the development and approval of Blue Cross of Idaho's formulary using both clinical and financial analysis of impact.
    • Coordinate the day-to-day relationship and operational management of the PBM. Ensure service guarantees are recorded and monitored. Ensure that contract provisions are carried out.
    • Represent BCI on the Pharmacy and Therapeutics Committee. Ensure new drugs, as identified through Medi-span reports or otherwise, are brought to Committee in a timely manner with a recommendation for inclusion/exclusion as well as utilization management and/or benefit positioning.
    • Support the prescription drug pre-authorization and step therapy programs. Ensure up-to-date criteria are maintained for review of the drug benefit. Provide expert consultative advice to plan Medical Directors on review of the pharmacy benefit.

    Additional skills that we are looking for:

    • Good verbal and written communication skills
    • Independent and critical thinking
    • PBM industry
    • Utilization management (step therapy, prior authorization)
    • Communicate effectively with both internal and external customers
    • Health Insurance pharmacy benefit design
    We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class


    We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

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