Senior Clinical Pharmacist

Blue Cross Blue Shield Association•Oklahoma City, OK

22h•$115,900 - $168,025•Hybrid

About The Position

This role supports the Federal Employees Program Part D/Employer Group Waiver Program pharmacy benefit across clinical pharmacy functions, including formulary development, coverage determinations and appeals, prior approval, and utilization-process maintenance. It provides clinical and plan-sponsor oversight for the Federal Employees Program Medicare Prescription Drug Program/Employer Group Waiver Plan. The role oversees delegated clinical functions, formulary administration, Centers for Medicare & Medicaid Services reporting, compliance, audit readiness, and coordination with the Pharmacy Benefit Manager and internal stakeholders. The pharmacist serves as a clinical subject matter expert on Medicare Part D benefit design, formulary administration, supplemental wrap coverage, utilization management, and coverage determinations. The role supports internal pharmacy workgroups and provides clinical guidance for presentations, plan education, executive updates, Office of Personnel Management responses, and cross-functional initiatives. It also participates in Medicare P&T and utilization-management activities and evaluates the impact of clinical and benefit changes.

Requirements

PharmD degree.
At least five years of pharmacy residency or three to five years of work experience in a health plan or Pharmacy Benefit Manager environment.
Knowledge of Medicare Part D, formulary and utilization-management requirements, delegated oversight, compliance, and audit readiness.
Strong clinical judgment, analytical, quality-control, communication, and cross-functional collaboration skills.
Excellent interpersonal skills and ability to work with all levels of the Association, Plans, government agencies, and vendors.
Strong written and oral communication skills.
Technical proficiency with information technologies, including Microsoft software applications such as Excel.
PharmD and pharmacist licensure required to perform clinical duties.
Experience indicative of an understanding of health care and patient care delivery and how health care professionals interact in the health care environment.
Experience with drug utilization review and formulary programs.

Nice To Haves

AI literacy and an understanding of generative AI tools, including appropriate business applications and limitations.

Responsibilities

Serve as the clinical subject matter expert for Medicare Part D benefit design, formulary administration, supplemental wrap coverage, utilization management, and coverage determinations.
Oversee delegated Pharmacy Benefit Manager clinical functions, performance, issues, corrective actions, and follow-up activities.
Review formulary and utilization-management materials and coverage determinations and appeals, including prior authorization, step therapy, quantity limits, transition requirements, and formulary changes.
Review, edit, and complete Employer Group Waiver Program Medicare submissions, formulary and Pharmacy and Therapeutics modules, transition supply materials, and other required submissions.
Review and download patient safety and other required files through the Health Plan Management System portal.
Support audit readiness, evidence validation, remediation tracking, and clinical quality-control reviews.
Review Part B versus Part D coverage requirements and support accurate benefit determinations and member communications.
Develop and maintain Medicare PDP oversight policies, procedures, controls, and process documentation.
Support internal pharmacy workgroups and provide clinical guidance for presentations, plan education, executive updates, Office of Personnel Management responses, and cross-functional initiatives.
Participate in Medicare P&T and utilization-management activities and evaluate the impact of clinical and benefit changes.