Senior Clinical Pharmacist, Medicare Trend, Cost of Care & Innovation

Blue Cross and Blue Shield of North Carolina • Durham, NC

2d • Hybrid

About The Position

The Medicare Cost of Care Pharmacist supports Blue Cross NC’s pharmacy cost management and affordability strategy by monitoring utilization and cost trends, identifying opportunities to improve value, and executing pharmacy initiatives that enhance program performance. This role collaborates across the enterprise—including formulary, utilization management, analytics, actuarial, product, and PBM partners—to ensure clinically appropriate, financially responsible, and compliant pharmacy outcomes.

Requirements

• Bachelor's degree or advanced degree
• 5+ years of experience in related field
• In lieu of degree, 7+ years of experience in related field
• Licensed pharmacist or eligible for licensure in North Carolina

Nice To Haves

• PharmD
• Managed care, Medicare, formulary, and/or PBM experience preferred
• Demonstrated analytical, communication, and cross‑functional collaboration skills

Responsibilities

• Identify and respond to emerging cost drivers; perform clinical deep dives and monitor the high-cost drug pipeline for opportunities to evaluate and mitigate cost drivers.
• Advise on annual formulary changes, Part B step therapy and clinical UM criteria based on trend analysis.
• Launch and monitor new initiatives like clinical DUR (cDUR) programs; Use trend drivers to grow High Touch Rx connectivity and opportunities with analytics to enhance program performance; connect with team analyst on quality review of Part D and Part B claims.
• Act as the clinical liaison to analytics and strategy teams, refining tools to track pharmacy programs such as quantity limit rationalization and GLP-1 oversight.
• Partner with Cost of Care, Actuary, Government Markets, and PBM stakeholders to ensure financial and clinical goals are met.
• Active participation in Medical Economics meetings, A&U, and Disease State Workgroups (such as Diabetes). Direct support for P&T Committee activities and future-state planning.
• Opportunities for mentorship and management of pharmacy students and residents.

Benefits

• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Number of Employees: 1,001-5,000 employees