Clinical Pharmacist - Medical Policy

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

3d

About The Position

This position leads medical policy efforts for prescription drugs, including strategy development, implementation, build, maintenance, quality review, and measurement of the prior authorization program. The role also serves as a liaison to the clinical appeals area and as lead pharmacist on the Pharmacy and Therapeutics Committee. It does not manage people and reports to the Manager, Pharmacy Medical Policy & Specialty Drug Management.

The pharmacist works with the BCBSLA pharmacy department, clinical areas of Medical Management, PBM clinical personnel, e-hosting formulary vendor personnel, and—when dedicated to Medical Policy—the Lead Medical Director for Medical Policy and the Medical Policy, Clinical Appeals, Professional and Facility Reimbursement, and Legal departments. Duties are performed in a normal, clean office environment with normal noise levels. Work is predominantly performed while standing or sitting.

Requirements

• Doctorate of Pharmacy or Bachelor's Degree in Pharmacy required.
• 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.
• Experience with software programs such as Word and Excel.

Nice To Haves

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

Responsibilities

• Serve as the companywide subject matter expert on specialty drug management strategies for medications covered under pharmacy and medical benefits, including monitoring the specialty pharmacy pipeline for products with anticipated clinical and financial impacts.
• Author and maintain medical policy clinical criteria, including decision-tree logic for phone, fax, and web-based authorizations; promote consistent authorization requirements within therapy classes; and monitor authorization, denial, and appeal rates.
• Serve as the lead BCBSLA pharmacist for 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; manage changes resulting from the Annual Formulary Update process.
• Collaborate with pharmacy reporting and analytics to measure utilization management program effectiveness, identify medical and pharmacy drug dosing and utilization management opportunities, manage medical drug rebate programs, and assess rebate opportunities.
• Maintain and update self-administered drug list programming to help ensure drugs intended for patient self-administration are not routinely reimbursed under the medical benefit.
• Perform other job-related duties within the scope of responsibilities.

What This Job Offers

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