Clinical Pharmacist - Clinical Consulting & Utilization Review (Hybrid)

Resp & Qualifications

PURPOSE:

The Clinical Pharmacist serves as a client-facing clinical consultant, partnering with pharmacy account consultants on data-driven, evidence-based pharmacy strategies to support sustainable drug cost management for large national accounts. Responsibilities include but are not limited to: account-specific pharmacy utilization reviews, responding to account-specific clinical inquiries, developing clinical pharmacy recommendations, and participating in pharmacy finalist presentations. This role is responsible for interpreting drug utilization trends, advising on clinical program optimization, translating complex pharmacy data into actionable insights, and supporting external client engagements through a consultative and collaborative approach. The pharmacist represents CareFirst pharmacy as a trusted clinical advisor to a variety of stakeholders, including brokers, key employer accounts, and internal sales teams.

ESSENTIAL FUNCTIONS:

• Serve as the primary clinical subject matter expert supporting pharmacy account consultants in external client interactions, including utilization reviews, strategic discussions, and finalist presentations. Provide ongoing clinical consultation to external clients, brokers, and internal stakeholders on emerging pharmacy trends, therapeutic advancements, and formulary strategy. Acts as a clinical consultant for pharmacy account consultants and internal sales team with the goal of fostering strong partnerships that enhance client value and experience.
• Partner closely with pharmacy account consultants to provide a unified, consultative experience for clients, ensuring alignment between clinical pharmacy strategy and account priorities. Assist with development and delivery of client-facing presentations that clearly communicate pharmacy utilization trends, market insights, clinical program performance, pharmacy strategy and strategic recommendations.
• Review and analyze account-specific pharmacy utilization, trend data and overall performance of formularies and/or utilization management to identify opportunities to improve clinical outcomes and cost efficiency. Evaluate the impact of clinical programs and recommend modifications based on performance insights and evolving standards of care. Work collaboratively with vendors, PBMs, accounts, and internal parties for oversight of clinical programs and performance management.
• Participate in the new pharmacy business process including but not limited to serving as a clinical pharmacy resource for review of written RFP responses and presenting at finalist meetings. Contribute clinical expertise to strategic discussions supporting new and existing business opportunities.
• Monitor and synthesize pharmacy market developments, including new drug approvals, pipeline trends, and competitor strategies and translate these market insights into practical recommendations that help inform client strategy and decision-making.

QUALIFICATIONS:

Education Level: Doctor of Pharmacy (PharmD).

Licenses/Certifications Upon Hire Required:

• PHARMD - Licensed Pharmacist No Direct Patient Care - Active Registered Pharmacist in any state and/or DC.

Experience: 5 years experience in clinical pharmacy, preferably in a managed care environment (PBM or health plan), or clinical consulting/sales environment.

Preferred Qualifications:

• Experience in account management/sales.
• Experience working in healthcare industry with a thorough understanding of prescription benefit management programs and practices.

Knowledge, Skills and Abilities (KSAs)

• Ability to work independently, as well as a member of a team.
• Strong critical reasoning skills in clinical decision-making, planning and organizing.
• Current knowledge of clinical practices and related information systems and computer applications, required.
• A strong balance between clinical expertise and business acumen.
• Strong interpersonal, written and verbal communication skills, including presentation skills.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Travel Requirements

Estimate Amount: 10%

Salary Range: $120,240 - $214,929

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate''s work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case''s facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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