Health Plan Pharmacist - Remote

Blue Cross Blue Shield of Arizona•Phoenix, AZ

1d•Remote

About The Position

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
Proficient in critical literature evaluation skills, including evidence-based medicine principles
Excellent problem-solving skills
Strong written and verbal communications.
Intermediate PC proficiency.
Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones.
Intermediate skill in word processing, spreadsheet and database software.
Intermediate skill using departmental BCBSAZ and BCBSA software.
Must have effective human relations and verbal/written communication skills and the ability to work collaboratively with community-based practitioners and the senior population is essential.
Must have an understanding of the interrelationships of health plan pharmacy components, members, and providers is required.
Proficiency with PC based productivity tools required.
Needs analytical ability to support decision making; organizational ability to manage multiple tasks and projects by established deadlines.
Flexible skills in an operationally changing environment, with drive for results based on planned objectives.
Strong customer service skills.
Interpersonal skills that allow for harmonious relationships with providers, members and coworkers.
Recognize strategic opportunities and use data to make timely and sound decisions.
Flexibility and willingness to adjust to shifting demands/priorities.
High standard of performance while pursuing aggressive goals
Ability to lead by example

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.