Pharmacist

Blue Cross Blue Shield of Massachusetts•Hingham, MA

14d•$118,000 - $147,290

About The Position

The Clinical Pharmacist Reviewer reviews formulary exception, prior authorization, and quantity limit exception requests from providers by phone and fax. The role supports Retail Pharmacy, Medicare Advantage Part D, Home Infusion Therapy, and Medical Utilization Management benefits. The work schedule is Monday through Friday, with rotational weekend and holiday support for timely Medicare Part D determinations. The pharmacist supports the implementation and management of pharmacy programs, helps maintain regulatory compliance, develops drug utilization programs and clinical opportunities, and provides drug information, training, analysis, and issue resolution for internal and external customers. The role also partners with clinical and non-clinical teams, supports special projects, and identifies workflow efficiencies and clinical quality and cost-saving opportunities.

Requirements

Professional Registered Pharmacist degree.
Unrestricted, current, and valid license to practice pharmacy in Massachusetts and/or another relevant or applicable state.
Experience in a managed care setting, from the provider, payer, or PBM side of the industry.
Proficiency with standard office-suite applications, including word processing and relational database manipulation.
Excellent written and oral communication skills.
Excellent interpersonal skills.
Strong organizational and time-management skills, including the ability to work independently and prioritize multiple projects and assignments.
Strength in analysis, problem identification, and issue resolution.
Strong teamwork skills and ability to use team approaches to goal setting and attainment.
Results-oriented.

Nice To Haves

Graduate study in business, public health, or health policy will be favorably considered.
Experience directly supervising technical support staff for clinical and/or service and operational programs is desirable.

Responsibilities

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