Clinical Pharmacist

Blue Cross & Blue Shield of Mississippi • Flowood, MS

4d • Onsite

About The Position

Healthy Careers Start Here
Be part of a vision for a healthier Mississippi as a Clinical Pharmacist. Our Clinical Pharmacist focuses on best practice patient care and medication optimization rather than routine dispensing or administration. Join our team and start a meaningful career where your work supports better health outcomes for Mississippians every day. At Blue Cross & Blue Shield of Mississippi, we are seeking Clinical Pharmacists to work in collaboration with the Chief Medical Director to review Prescription Drug Prior Authorization Requests and Appeals for coverage and medical necessity determinations. This Pharmacist also reviews drug database information and drug utilization activity to ensure proper pharmacy benefits administration and makes recommendations for benefit design based on data and trends.
There are currently two positions available.

Requirements

• Doctor of Pharmacy (PharmD) degree.
• Current Mississippi Pharmacist license (or intent to get same).
• One year or more experience in a fast-paced general retail pharmacy setting.
• Clinical pharmacy knowledge.
• Understanding basic economic principles and the ability to apply them to the utilization management setting.
• Intermediate proficiency using Microsoft Office, specifically Word and Excel.
• Advanced organizational and multitasking skills with the ability to prioritize competing tasks and perform them with accuracy simultaneously.
• Skilled in using clinical terminology to communicate effectively across interdisciplinary teams, including physicians, nursing staff, and administrative personnel.
• Skilled in detailing analytical processes in written form and clearly articulating the rationale behind complex determinations.
• Ability to work at a high degree of accuracy with information that is confidential in nature.

Nice To Haves

• Residency is preferred.
• Previously managed care or pharmacy benefits management experience.

Responsibilities

• Conduct clinical reviews of Prescription Drug Prior Authorization Requests and Prescription Drug Appeals against Prescription Drug Benefits, Medical Policy Guidelines, prescribing information and compendia.
• Research and gather necessary information to complete comprehensive reviews.
• Make objective determinations and recommendations based on information, knowledge and experience.
• Consult with Physician Reviewer to make final determinations.
• Communicate decisions to Prescribing Provider, Specialty Pharmacy and Member as appropriate.
• Meet quality and production rates to maintain established timelines.

Benefits

• medical benefits
• 401(k)
• ample paid time off
• a schedule that supports true work/life balance
• comprehensive benefits package that is worth approximately one-third of the salary compensation

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Ph.D. or professional degree