Clinical Pharmacist

Arkansas Blue Cross Blue Shield • Little Rock, AR

7d • $125,000 - $158,550 • Hybrid

About The Position

The Clinical Pharmacist reports to and operates under the direction of Pharmacy Leadership, and works cooperatively and, at times, independently with medical directors and enterprise personnel. The position may be assigned to a specific scope or line of business, such as Care Management or Utilization Management. This is a hybrid role based in Little Rock, Arkansas, requiring at least three days in the office each week.

The role supports the enterprise’s pharmacy utilization, prior authorization, cost containment, coverage review, and medication management programs. The pharmacist applies clinical knowledge and independent critical thinking to review requests, advise internal teams and providers, develop pharmacy policies and strategies, and help ensure members receive medications without unnecessary treatment delays.

Requirements

• Bachelor's degree in Pharmacy from an accredited college of pharmacy.
• Active, current, unrestricted pharmacy license in the state(s) where job duties are performed.
• Minimum of three years of pharmacy practice experience.
• Pharmacist License from the Arkansas State Board of Pharmacy is listed under certifications.
• Skills listed: coaching others, conflict resolution, continuous learning, critical thinking, employee engagement strategies, evaluating information, interpersonal communication, interpersonal relationships, management techniques, monitoring processes/materials/surroundings, oral communications, problem sensitivity, researching, service orientation, task delegation, time management, and written communication.

Nice To Haves

• Minimum of three years of experience in managed pharmacy care and drug utilization review preferred.
• Preference for individuals with one or more years of experience in medical pharmacy utilization management.

Responsibilities

• Assist in developing and supervise the drug utilization and prior authorization review program.
• Develop and implement pharmacy cost containment strategies tailored to enterprise situations and patterns, specific regions, and large accounts.
• Draft pharmaceutical criteria and perform other activities supporting the enterprise prior authorization program.
• Keep current on medication information and contribute to identifying pharmacy program best practices, collaborating with Medical Directors, leadership, and clinical departments as a subject matter expert.
• May conduct second-level reviews of medical and pharmacy benefit medication prior authorizations, exceptions, and medical necessity reviews submitted to the plan.
• May ensure appropriate alignment of medical policies and configuration for claims processing and utilization management.
• Prepare and present reports, data, and analyses on utilization and cost trends for enterprise lines of business, specific regions, and large accounts.
• Provide leadership and advice on developing and implementing pharmacy reimbursement and claims processing policies and procedures, and on pharmacy vendor selection.
• Review and interpret coverage across assigned lines of business to determine the type of review required; work with requesting providers, corporate medical directors, and other internal staff to determine whether case presentations meet applicable approval criteria.
• Serve as a liaison to individual pharmacists, professional pharmacy organizations, internal committees, case management, medical management, and other providers on pharmacy issues.
• Support pharmacy initiatives for member, provider, and client satisfaction.
• Use clinical knowledge and independent critical thinking to interpret criteria, policies, and procedures and make determinations on prior approval reviews, retrospective reviews, and/or pharmacy consultations within case management.
• Use knowledge of pharmacy and/or medical benefits to communicate with and provide recommendations to Care Management nurses, social workers, and medical directors.
• Use knowledge of pharmacy and/or medical benefits to help ensure members receive medications in a timely fashion and avoid treatment delays.
• Perform other duties as assigned.

What This Job Offers

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