Pharmacist

Blue Cross Blue Shield of Massachusetts•Hingham, MA

10d•Onsite

About The Position

The Clinical Pharmacist Reviewer reviews formulary exception, prior authorization and quantity limit exception requests from providers via phone and fax for the Retail Pharmacy, Medicare Advantage Part D, Home Infusion Therapy, and Medical Utilization Management benefits.

Requirements

Minimum of professional Registered Pharmacist degree required.
Unrestricted current and valid license to practice pharmacy in the state of Massachusetts and/or in any other relevant/applicable state
Experience in a managed care setting, either from the provider, the payer, or the PBM side of the industry, is required.
Proficiency in standard computational office-suite applications, including word-processing and relational database manipulation is required.
Excellent written and oral communication skills
Excellent interpersonal skills
Strong organizational and time management skills, including ability to work independently and prioritize multiple projects and assignments
Demonstrated strength in analysis, identification of problems and issue resolution
Excellent skills in teamwork and team approaches to goal setting and attainment
Must be results oriented.
High school degree or equivalent required unless otherwise noted above

Nice To Haves

Graduate study in a business, public health, or health policy field will be favorably considered.
Experience in direct supervision of technical support staff for clinical and/or service and operational programs is desirable.

Responsibilities

Participation in Prior Authorization, Formulary Exception, Step Therapy and Quality Care Dosing program implementation and management
Support Pharmacy Operations analysts in executing day-to-day approvals and denials in order to maintain compliance with all regulatory requirements.
Support product portfolio, including Medicare Part D which includes rotational weekend and holiday support for timely determinations.
Support the Home Infusion Therapy, Specialty Pharmacy Network and Medical Utilization Management for pharmaceuticals programs
Partner with clinical and non-clinical teams for staff training, facilitation of meetings and other ad hoc presentations.
Participate in the development and design of drug utilization programs and new clinical program opportunities
Facilitate special projects as assigned
Develop drug information, training and support to all internal and external customers
Provide analysis and resolution for issues from MAPS, Health and Medical Management, IT & Ops, PBM account support team and other customer service areas
Develop strategies for effective communication of program initiatives in partnership with Clinical Pharmacy for internal and external customers
Identify opportunities for workflow efficiencies and new clinical quality and cost saving programs