Job Description

Awarded the Best Place to Work 2021, Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

This position exercises broad strategic and operational oversight for planning, organizing and directing all aspects of Blue Cross® Blue Shield® of Arizona Medicare clinical pharmacy programs including but not limited to all Medicare Part D, Part B and stand-alone prescription drug plan programs and compliance requirements, formulary design and maintenance, and pharmacy utilization / quality management. Acts as primary clinical pharmacy, operations and compliance liaison with the designated pharmacy benefits manager (PBM).

REQUIRED QUALIFICATIONS

Required Work Experience

Required Work Experience

  • Ten years’ experience in leadership in a Medicare Advantage managed care environment
  • Two years’ experience in a PBM environment.
  • Five years of progressively responsible administrative leadership experience in a healthcare related setting.
  • Ten years of experience in managed care

Required Education

  • BS in Pharmacy degree or related field

Required Licenses

Required Certifications

  • N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience

  • Additional geriatric fellowship training and / or direct hands on pharmacy benefits management experience.
  • Additional related education and/or experience preferred.

Preferred Education

  • Pharm D with residency or fellowship

Preferred Licenses

  • Active, current and unrestricted State of Arizona (a state in the United States) pharmacist license

Preferred Certifications

  • Certified Geriatric Pharmacist (CGP)

 

ESSENTIAL job functions AND RESPONSIBILITIES

  • Directs the planning and implementation of the BCBSAZ  Medicare Clinical Pharmacy and Part D Services functions.
  • Provides operational support of the medical part B drug management program including selection of drugs for utilization management, interface with claims processing systems, audit and ensuring CMS compliance.
  • Ensures initial and continuing competency of staff under their respective responsibility. Initiates recruitment, selection, and provides for training, development, coaching, and motivation of employees. Further, maintains and encourages a positive working environment through a variety of communication systems, positive recognition, intervention and practices resignation recovery.
  • Provides strategic direction, operational oversight, and financial impact analysis for all Medicare clinical pharmacy programs and all Medicare Part D mandated programs.
  • Ensures compliance with all CMS, Medicare Part D and Arizona Department of Insurance requirements for pharmacy services, pharmacy benefits, P & T committee, formulary development and maintenance, quality assurance and member safety, medication therapy management programs coordination with CCIP programs, pharmacy utilization management, exceptions, prior authorization, step therapies, grievance and appeals.
  • Serve as owner of and liaison with  designated PBM relationship to ensure compliance and operational efficiency related to pharmacy claims processing, claims reversals, Troop tracking and reporting, coordination of benefits, EOB determinations and reporting, low income subsidy, Reinsurance calculations, Drug Claims data encountering, pharmacy access monitoring, home infusion pharmacy monitoring, long term care pharmacy monitoring, ITU pharmacy monitoring, Part D reporting. Leads joint operations with the designated PBM to facilitate all Part D implementation issues, and ongoing operational issues.
  • Develop and analyze efficiency and quality metrics and improves performance on a continuous basis.
  • Takes leadership in the financial and services evaluation of PBM vendors through requests for proposal and market checks.
  • Takes leadership in PBM prescription claims pricing audits.
  • Acts as subject expert in all Medicare clinical pharmacy areas and provides ongoing education to internal partners, members, and Network physicians.
  • Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers with an excellent service experience by consistently demonstrating core and leader behaviors each and every day.
  • The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
  • Perform all other duties as assigned

REQUIRED COMPETENCIES

Required Job Skills

  • N/A

Required Professional Competencies

  • Analytical and critical thinking skills are required to integrate and interpret data from diverse sources.
  • Able to integrate information to establish business-based priorities, decisions and budgets.
  • Ability to develop strong relationships with suppliers and customers and to effectively communicate with employees, medical staff, and management staff.
  • Strong interpersonal skills are required.
  • Able to communicate effectively at all levels and demonstrate leadership ability and group facilitation skills.

Required Leadership Experience and Competencies

  • N/A

PREFERRED COMPETENCIES

Preferred Job Skills

  • N/A

Our Commitment

BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona.  For more information on our company, see azblue.com.  If interested in this position, please apply.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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