Clinical Pharmacist - Medical Policy

Blue Cross and Blue Shield of Louisiana•Baton Rouge, LA

4d•Onsite

About The Position

This position is responsible for leading the medical policy efforts of prescription drugs, which includes strategy development, implementation, build, maintenance, quality review, and measurement of the prior authorization program. This position also serves as a liaison to the clinical appeals area and serves as lead pharmacist on the Pharmacy and Therapeutics Committee.

Requirements

Doctorate of Pharmacy required or Bachelor's Degree in Pharmacy required
1 year of experience working in clinical pharmacy roles and supporting P&T Committee and/or drug information activities required
Experience with software programs such as Word and Excel is a must
Current pharmacy license in good standing required

Nice To Haves

Residency in or relocation to Louisiana is preferred for all positions.
1 year of experience in managed care preferred
knowledge of PowerPoint preferred
Participation in ASHP or AMCP-accredited residency program preferred

Responsibilities

Serve as companywide subject matter expert regarding specialty drug management strategies of medications covered under both the pharmacy and medical benefits, including specialty pharmacy pipeline monitoring to identify new products that are expected to have major clinical and financial impacts on drug trend, for the purpose of ensuring BCBSLA’s coverage of specialty drugs are current, clinically sound, and cost-effective.
Serves as lead author of medical policy clinical criteria which includes the development, updating, and maintenance of decision tree logic used to support phone, fax, and web-based authorizations; includes consistency of authorization requirements within therapy classes; and includes monitoring the results of the authorization process (i.e., authorization, denial, and appeal rates) for the purpose of ensuring BCBSLA’s drug utilization management programs are current, clinically sound, efficient, and cost-effective.
Serve as lead BCBSLA pharmacist to the Pharmacy and Therapeutics Committee ; pharmacist liaison to the Clinical Appeal areas; leads review and discussion of drugs that are new to market, have new indications, or updated safety profiles and primarily accountable for change management functions as a result of the Annual Formulary Update process.
Collaborates with pharmacy reporting and analytics for the purpose of measuring utilization management program effectiveness, identifying medical and pharmacy drug dosing and utilization management opportunities, managing medical drug rebate programs, and providing rebate opportunity assessments.
Responsible for maintenance and updating of self-administered drug list programming for purpose of ensuring that drugs intended to be self-administered by patients are not routinely reimbursed under the medical benefit.
Perform other job-related duties as assigned, within your scope of responsibilities.