Health Plan Pharmacist

Blue Cross Blue Shield of Arizona•Phoenix, AZ

4d•Remote

About The Position

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements: Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month Onsite: daily onsite requirement based on the essential functions of the job Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week. This position is remote within the state of AZ only. This remote work opportunity requires residency, and work to be performed, within the State of Arizona. Purpose of the job This position is responsible for maintaining and supporting the Medicare and/or Medicaid formulary and providing clinical and economic data necessary to make formulary decisions. This position acts as a pharmacy resource for network physicians, health plan members, medical services, care management, and member service staffs as well as other internal partners. Assists in performing all CMS mandated quality and compliance activities. Serves as a pharmacy topic educator and training resource to Medicare and/or Medicaid health plan departments and personnel. This position has the latitude for independent decision-making within the limits of acceptable standards of pharmacy practice and state and federal laws. This position requires interactions at all levels of staff and management. External interactions include network physicians, and health plan members, etc.

Requirements

5 years or more as a practicing pharmacist
3 years of experience in the managed care pharmacy field
2 years of direct prior authorization experience
2 years of managed care/health plan and/or pharmacy benefits experience.
Doctor of Pharmacy (Pharm.D) degree
Active, current and unrestricted State of Arizona (a state in the United States) pharmacist license

Nice To Haves

Medicare Part D experience highly desirable.
Pharm. D with residency or fellowship preferred
Geriatric certification

Responsibilities

Provides and assists with the management of pharmacy services to Medicare and/or Medicaid health plan members that is consistent with acceptable standards of pharmacy practice and applicable regulations and guidance.
Assists in defining, implementing and managing Medicare and/or Medicaid health plan pharmacy programs including the medication therapy and drug utilization management.
Directly interfaces with Medicare and/or Medicaid members, and network providers concerning pharmacy issues and programs.
Designs and delivers staff/community educational programs and provides individual medication counseling, if appropriate.
Produces pharmacy utilization reports as well as clinical and economic data to the health plan to assist in pharmacy benefit utilization analysis.
Conducts audits and produces reports that can be utilized by the care management, quality and compliance departments to evidence quality pharmacy services and meets Medicare and/or Medicaid requirements.
Applies the principles of continuous quality improvement consistent with job expectations.
Incorporates quality improvement principles into other activities and projects (i.e. data collection, documentation).
Develops criteria for drug use evaluations, medication use indicators and disease-based evaluations.
May be assigned to create data extracts of the pharmacy claims system and support ad hoc report requirements for health plan pharmacy utilization management and audit functions.
Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards.
Provides all customers with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.
Perform other duties as required.