Clinical Pharmacist

Arkansas Blue Cross•Little Rock, AR

6d•Hybrid

About The Position

The Clinical Pharmacist reports to and operates under the direction of Pharmacy Leadership. The role works cooperatively and, at times, independently with medical directors and enterprise personnel, and may be assigned to a specific scope or line of business, such as Care Management or Utilization Management. The position supports pharmacy utilization management and prior authorization programs, develops pharmaceutical criteria and pharmacy cost-containment strategies, and provides clinical expertise on medication information and pharmacy program practices. It may include second-level reviews of medical and pharmacy benefit medication authorizations, exceptions, and medical-necessity requests, as well as ensuring alignment of medical policies and claims-processing configurations. The pharmacist also analyzes utilization and cost trends, advises on pharmacy reimbursement and vendor selection, and collaborates with providers and internal teams to support appropriate, timely medication access and member, provider, and client satisfaction. This is a hybrid role in the Little Rock, Arkansas location, requiring at least three days in the office each week. The position is identified as security level three and must protect the security and confidentiality of records and information and adhere to the company’s segregation-of-duties guidelines. The stated ADA category is general office worker, sedentary, with campus travel within walking distance of the primary work assignment.

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.
Arkansas State Board of Pharmacy pharmacist license, as listed under certifications.

Nice To Haves

Minimum of three years of experience in managed pharmacy care and drug utilization review is preferred.
Preference given to candidates with one or more years of experience in medical pharmacy utilization management.

Responsibilities

Assists in developing and supervises the drug utilization and prior authorization review program.
Develops and implements pharmacy cost-containment strategies tailored to enterprise, regional, and large-account needs and patterns.
Drafts pharmaceutical criteria and performs other activities supporting the enterprise prior authorization program.
Keeps current on medication information and contributes 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.
Prepares and presents reports, data, and analyses on utilization and cost trends for enterprise lines of business, regions, and large accounts.
Provides leadership and advice on developing and implementing pharmacy reimbursement and claims-processing policies and procedures, and on pharmacy vendor selection.
Reviews and interprets coverage across assigned lines of business to determine the type of review required; works with requesting providers, corporate medical directors, and internal staff to determine whether cases meet applicable approval criteria.
Serves as a liaison to pharmacists, professional pharmacy organizations, internal committees, case management, medical management, and other providers on pharmacy issues.
Supports pharmacy initiatives for member, provider, and client satisfaction.
Uses clinical knowledge and independent critical thinking to interpret criteria, policies, and procedures and make determinations on prior-approval and retrospective reviews and/or pharmacy consultations within case management.
Uses pharmacy and/or medical benefit knowledge to communicate with and provide recommendations to Care Management nurses, social workers, and medical directors.
Uses pharmacy and/or medical benefit knowledge to help ensure members receive medications in a timely manner and avoid treatment delays.
Performs other duties as assigned.