Clinical Pharmacist/Pharmacist
About The Position
Responsible for promoting appropriate and/or efficient utilization review of prescription drug claims among BCBSM participating physicians. This position is also responsible for the education of physicians and influencing of prescribing patterns to reduce BCBSM’s drug benefit payout and improve the quality of the benefits as it relates to our members. The incumbent serves as the liaison to the Medical Policy department assisting with the development of medical policy as it applies to drugs. Participate in clinical coverage review of medication requests, including detection of medication fraud, waste and abuse. Develop, implement and update Drug Utilization Review/Evaluation Programs. Provide effective and efficient communication of pharmacotherapy issues. Develop and implement a variety of behavior modification principles to influence physicians to prescribe appropriately. Identify target physicians, establish credibility and utilize both verbal and written communications to modify behavior. Serve as the key clinical support person for researching prescription drug inquiries. Develop, implement and continually update physician and patient educational materials. Support Drug Formulary development, management and publishing of written and web-based Drug Lists and other pharmacy materials and support the BCBSM/BCN P and T Committee. Serve as liaison to medical Policy assisting with the development of medical policy as it applies to drugs. Participate in clinical and operational process improvement and cost savings opportunities. Support review and resolution of clinical and compliance grievances and appeals. Support clinical initiatives related to NCQA, HEDIS, QRS, CAHPS and STAR measures. Adhere to Pharmacy Policies and Procedures.
Requirements
- Bachelor's Degree or Doctorate in Pharmacy required.
- At least three (3) years of experience consulting with physicians on pharmaceutical issues or completion of an accredited ASHP or AMCP or Managed Care Pharmacy or Pharmacy Practice Residency.
- Current unrestricted Michigan pharmacy license.
- Experience as a Clinical Pharmacist is required.
- Drug Information Specialist with proven background and skills will also be considered.
- Superior oral and written communication skills.
- Expertise in the design of presentations.
- Ability to obtain and devise relevant data and information from existing MIS Systems.
Nice To Haves
- An understanding or knowledge of drug claims processing systems and/or medical information systems is preferred.
Responsibilities
- Promote appropriate and/or efficient utilization review of prescription drug claims.
- Educate physicians and influence prescribing patterns.
- Serve as liaison to the Medical Policy department for drug-related medical policy development.
- Participate in clinical coverage review of medication requests, including detection of medication fraud, waste and abuse.
- Develop, implement, and update Drug Utilization Review/Evaluation Programs.
- Provide effective and efficient communication of pharmacotherapy issues.
- Develop and implement behavior modification principles to influence physician prescribing.
- Identify target physicians and utilize communication to modify behavior.
- Serve as key clinical support for researching prescription drug inquiries.
- Develop, implement, and update physician and patient educational materials.
- Support Drug Formulary development, management, and publishing.
- Support the BCBSM/BCN P and T Committee.
- Participate in clinical and operational process improvement and cost savings opportunities.
- Support review and resolution of clinical and compliance grievances and appeals.
- Support clinical initiatives related to NCQA, HEDIS, QRS, CAHPS and STAR measures.
- Adhere to Pharmacy Policies and Procedures.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
