Clinical Pharmacist - Medical Policy

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

About The Position

The Clinical Pharmacist leads medical policy efforts for prescription drugs, including the strategy, implementation, development, maintenance, quality review, and measurement of the prior authorization program. The role also serves as a liaison to clinical appeals and as lead pharmacist for the Pharmacy and Therapeutics Committee. It does not manage people and reports to the Manager, Pharmacy Medical Policy & Specialty Drug Management. The pharmacist serves as a companywide subject matter expert on specialty drug management across pharmacy and medical benefits; develops and maintains medical policy clinical criteria and authorization decision logic; reviews new drugs, indications, and safety information; and helps measure utilization management effectiveness and identify drug-management and rebate opportunities. The position also maintains self-administered drug list programming to ensure such drugs are not routinely reimbursed under the medical benefit. The job is performed in a normal, clean office environment with normal noise levels. Work is predominantly performed while standing or sitting. Residency in or relocation to Louisiana is preferred. Applicants must be authorized to work in the United States without employer-sponsored immigration support.

Requirements

Doctorate of Pharmacy or Bachelor's Degree in Pharmacy.
At least 1 year of experience working in clinical pharmacy roles and supporting P&T Committee and/or drug information activities.
Proficiency in pharmacology, therapeutics, and knowledge of disease management programs.
Strong interpersonal, organizational, oral and written communication, and clinical skills.
Current pharmacy license in good standing.
Proficiency with software programs such as Word and Excel.
Must be authorized to work for Louisiana Blue in the United States without employer-sponsored immigration support.

Nice To Haves

Residency in or relocation to Louisiana is preferred.
At least 1 year of experience in managed care.
Knowledge of PowerPoint.
Participation in an ASHP- or AMCP-accredited residency program.

Responsibilities

Lead specialty drug management strategies for medications covered under pharmacy and medical benefits, including monitoring the specialty pharmacy pipeline for products with significant clinical or financial impact.
Author, develop, update, and maintain medical policy clinical criteria and decision-tree logic for phone, fax, and web-based authorizations.
Promote consistency of authorization requirements within therapy classes and monitor authorization, denial, and appeal rates.
Serve as lead BCBSLA pharmacist to the Pharmacy and Therapeutics Committee and as pharmacist liaison to Clinical Appeals.
Lead review and discussion of drugs that are new to market, have new indications, or have updated safety profiles.
Lead change-management functions resulting from the Annual Formulary Update process.
Collaborate with pharmacy reporting and analytics to measure utilization management effectiveness and identify medical and pharmacy drug dosing and utilization management opportunities.
Manage medical drug rebate programs and provide rebate opportunity assessments.
Maintain and update self-administered drug list programming to help ensure those drugs are not routinely reimbursed under the medical benefit.
Perform other job-related duties as assigned within the scope of responsibilities.