Medicare Clinical Pharmacist - MTM

Blue Cross and Blue Shield of Louisiana•Monroe, LA

5d•Onsite

About The Position

Engages members who meet CMS criteria for MTM to review and assess complex medication regimens, counsel on medications and supplements, address pharmacy-related care gaps, and collaborate with the BCBSLA care management team to improve outcomes and reduce costs. Perform comprehensive medication reviews per CMS MTM Program Standards using claims, clinical/lab values, and member-reported usage. Work directly with members and prescribers to resolve adherence and other medication-related problems (care gaps, adverse events, regimen optimization). Maintain thorough knowledge of pharmacy benefits (formulary, outreach programs, UM tools, medical policies). Provide evidence-based therapeutic recommendations to promote innovative member management and cost-effective care. Ensure compliance with applicable laws and regulations.

Requirements

Doctorate of Pharmacy (PharmD) or Bachelor’s in Pharmacy.
1 year of experience working in a healthcare and/or managed care setting OR successful completion of a relevant Louisiana Blue externship
Current Louisiana pharmacist license in good standing.
Proficiency in pharmacology/therapeutics; strong interpersonal, organizational, and communication skills; Word/Excel proficiency

Nice To Haves

ASHP or AMCP-accredited residency and/or master’s training.
Rounding with physicians/ancillary staff, MTM certification, managed care experience, LTC consulting, specialty medication management

Responsibilities

Perform comprehensive medication reviews per CMS MTM Program Standards using claims, clinical/lab values, and member-reported usage.
Work directly with members and prescribers to resolve adherence and other medication-related problems (care gaps, adverse events, regimen optimization).
Maintain thorough knowledge of pharmacy benefits (formulary, outreach programs, UM tools, medical policies).
Provide evidence-based therapeutic recommendations to promote innovative member management and cost-effective care.
Ensure compliance with applicable laws and regulations.
Perform other job-related duties as assigned, within your scope of responsibilities.