Clinical Pharmacist

Capital Blue Cross • Harrisburg, PA

7d • Hybrid

About The Position

This position is responsible for the development, maintenance, and evaluation of pharmacy clinical initiatives and utilization management programs to assure a consistently cost-effective and quality pharmaceutical services and benefits for plan members. The incumbent manages the drug formulary program as well as clinical activities and oversees the clinical program administration by the pharmacy benefit management (PBM) company. The incumbent also serves as a resource to providing clinical support to committees and workgroups such as Pharmacy and Therapeutics Committee, Medical Policy Committee, Quality Management Committee, Delegation Oversight, and HEDIS/NCQA. The incumbent possesses good clinical/analytical skills and sound decision-making capabilities to identify opportunities/risks and propose benefit program quality/utilization management strategies accordingly. Strong interpersonal and excellent communication skills are essential due to interaction with various members of the medical profession, managed care clients, and external organizations.

Requirements

• Strong interpersonal and team skills with ability to work and interact externally and internally.
• Ability to communicate effectively with varied audiences, including ability to lead meetings, develop teamwork, and deliver verbal presentations.
• Ability to take direction from various levels of staff and perform project work with minimal supervision.
• Strong clinical/analytical skills and decision-making capabilities required.
• Strong interpersonal and excellent communication skills required.
• Ability to assess utilization data to identity new opportunities.
• In-depth knowledge of drug formulary systems and drug evaluation process.
• Broad knowledge of outpatient drug benefit and utilization management programs.
• Knowledge of pharmacy claims processing along with applicable state/federal laws.
• Experience in developing pharmacy clinical protocol, policies, and procedures.
• Experience in design/deployment of programs to increase quality of care and decrease costs.
• Pharmacy degree and current Pennsylvania pharmacy license required.

Nice To Haves

• Managed care knowledge and experience preferred.
• Knowledge and experience with Medicare Part D and NCQA accreditation preferred.
• Knowledge and experience with therapy medication and disease state management.
• Possess working knowledge of medical and pharmacy data integration to close gap in care and facilitate greater care coordination.
• Advanced pharmacy degree (Masters or Pharm.D.) preferred.

Responsibilities

• Formulary management including drug evaluation, P&T Committee, and related physician and member collaterals
• Pharmaceutical utilization and trend management via pharmacy clinical initiatives
• PBM vendor clinical services and programs oversight
• Specialty pharmaceutical management
• Pharmacy clinical and utilization management criteria, protocol, policies, and procedure development
• Provide clinical and drug information support
• Maintain regulatory including Medicare Part D, and accreditation compliance
• Develop member and provider educational programs
• Conduct presentation and training
• Maintain provider and pharmaceutical industry/drug manufacturer relations.
• Staff supervision

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Retirement Plan
• Paid Time Off
• Holidays
• Volunteer time off
• Incentive Plan
• Tuition Reimbursement

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level