Pharmacist Consultant

California Physicians' Service • Rancho Cordova, CA

421d • $118,800 - $178,200

About The Position

The Pharmacist, Consultant role within the Pharmacy Services Drug Utilization Management team at Blue Shield of California focuses on providing expert pharmacotherapy support for outpatient medical benefit inquiries. This position is responsible for ensuring the implementation of evidence-based clinical decisions made by the Pharmacy and Therapeutics Committee, promoting safe and cost-effective medication prescribing practices.

Requirements

• Doctor of Pharmacy (PharmD) degree required.
• Currently active and unrestricted California Registered Pharmacist (RPh) license required.
• At least 2 years of experience in clinical pharmacy required.
• Thorough knowledge of therapeutic use of medications required.
• Excellent oral and written communication skills required.

Nice To Haves

• Prior experience in managed care/PBM preferred.

Responsibilities

• Provide pharmacotherapy expertise for Blue Shield's pharmacy program, supporting the Pharmacy and Therapeutics Committee, drug formulary, drug prior authorization, and utilization review programs.
• Operate in compliance with all regulatory and accreditation requirements, and corporate policies regarding access to safe and medically necessary medications.
• Assist in preparing materials for audits and reports; complete assigned projects.
• Support the operational and clinical implementation of medication policies for drugs provided under the medical benefit for Commercial, Medicare, and Medi-Cal lines of business.
• Support the peer-to-peer process and facilitate provider discussions regarding prior authorization denials.
• Provide pharmacist support for the drug prior authorization program, ensuring requests are reviewed within regulatory time frames.
• Ensure compliance with various regulatory and quality accreditation requirements around drug utilization management.
• Serve as an educational resource regarding the Blue Shield drug formulary, medication policies, and appropriate drug use.

Benefits

• Competitive salary based on experience and location.
• Opportunities for professional development and continuing education.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Ph.D. or professional degree