Brand Messaging, Call Centers, Clinical Support, Communication Skills, Consulting, Corporate Policies, Formulary, Health Plan, Material Audit, Medicare, Medications, Outpatient Care, Pharmacy, Presentation/Verbal Skills, Regulations, Regulatory Compliance, Utilization Management, Work From Home, Writing Skills
Your Role
The Prior Authorization (PA) team utilizes clinical knowledge to review authorization requests for coverage under the outpatient pharmacy benefit. The Pharmacist, Consultant will work as part of the pharmacy benefit Prior Authorization (PA) team to support the Blue Shield of California (BSC) Pharmacy and Therapeutics Committee (P&T) by ensuring that evidence based clinical decisions are implemented appropriately to provide a high-quality and cost-effective pharmacy benefit. The Pharmacist, Consultant (Drug Utilization Review Pharmacist) will report to the Drug Utilization Review (DUR) Pharmacist Manager.
Your Knowledge and Experience
Requires a Doctor of Pharmacy (PharmD) degree
Requires a currently active and unrestricted California Registered Pharmacist (RPh) license
Requires at least 2 years of experience in clinical pharmacy
Previous experience working at a health plan is preferred
Prior authorization experience is preferred
Excellent oral and written communication skills
Thorough knowledge of therapeutic use of medications
Hybrid Virtual Work
This role allows employees to work virtually full-time, however employees will be expected to come into the office based on business needs.
Your Work
In this role, you will:
- Support the clinical and operational implementation of P&T approved policies for the pharmacy benefit, for both the Commercial and Medicare lines of business
- Apply clinical expertise to PA reviews and work collaboratively with the PA and Call Center Teams to support access to safe, efficacious, and medically necessary medications
- Operate in compliance with all regulatory and accreditation requirements to ensure all requests are reviewed within regulatory required timeframes
- Serve as a resource to internal and external constituents regarding the Blue Shield drug formulary, medication policies and appropriate drug use
- Embrace BSC values by answering clinical and operational questions, participating in group discussions, and supporting other team members while working towards a collective goal
- Use clear and concise communications and on-brand messaging when communicating with providers or members
- Follow all corporate policies and procedures
- Operate in compliance with all regulatory and accreditation requirements, and corporate policies and procedures regarding the support access to safe, efficacious, and medically necessary medications
- Assist in preparing materials for audits and reports; complete projects as assigned
Your Work
In this role, you will:
- Support the clinical and operational implementation of P&T approved policies for the pharmacy benefit, for both the Commercial and Medicare lines of business
- Apply clinical expertise to PA reviews and work collaboratively with the PA and Call Center Teams to support access to safe, efficacious, and medically necessary medications
- Operate in compliance with all regulatory and accreditation requirements to ensure all requests are reviewed within regulatory required timeframes
- Serve as a resource to internal and external constituents regarding the Blue Shield drug formulary, medication policies and appropriate drug use
- Embrace BSC values by answering clinical and operational questions, participating in group discussions, and supporting other team members while working towards a collective goal
- Use clear and concise communications and on-brand messaging when communicating with providers or members
- Follow all corporate policies and procedures
- Operate in compliance with all regulatory and accreditation requirements, and corporate policies and procedures regarding the support access to safe, efficacious, and medically necessary medications
- Assist in preparing materials for audits and reports; complete projects as assigned
B
Blue Cross and Blue Shield Association
At the Blue Cross and Blue Shield Association (BCBSA), we provide business strategy, technical support and consulting expertise to 36 Blue Cross and Blue Shield companies across the nation, employing more than 1,000 of the best strategic thinkers in the industry. We are a Brand manager that sets quality control standards for the 36 independent companies that use the Blue Cross and Blue Shield Brands, and we serve as a trade association that represents these Blue companies. It is through our involvement that the Blues companies share a united vision and strategy while also benefiting from the local strength of all member companies.
2,000 to 2,499 employees
https://www.bcbs.com/about-us/careers