FEP Clinical Pharmacist-3 years Managed Care experience required
Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,800 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.
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.
Internal use only-Grade 35
Provide utilization and drug interaction of drug therapies to include review of prior authorization requests according to FEP member benefits and coverage criteria. Perform member specific interventions through provider collaboration and comprehensive medication review with a focus on cost savings, HEDIS measure gap closure, and reduction of readmissions.
REQUIRED QUALIFICATIONSRequired Work Experience
- 3 years or more as a practicing pharmacist
- 3 years or more experience in the managed care pharmacy field
- Doctor of Pharmacy (Pharm.D) degree
- Active, current and unrestricted State of Arizona (a state in the United States) pharmacist license
- Specialty certification in Medication Therapy Management (may obtain certification within 6 months of job entry)
PREFERRED QUALIFICATIONSPreferred Work Experience
- 5 years or more as a practicing pharmacist
- 5 years or more of experience in the managed care pharmacy field
- 2 years of experience with Medicare Part D formulary and utilization management
- 2 years of experience in performing Medication Therapy Management
ESSENTIAL job functions AND RESPONSIBILITIES
- Collaborate with FEP Management, FEP Operations, and FEP HEDIS to create clear communication to FEP members and/or network providers on medication therapy recommendations.
- Work in partnership with FEPDO and Pharmacy Management team.
- Regularly collaborate with other plan pharmacy reps and programs.
- Collaborate with FEP Management and HEDIS staff for targeted FEP ongoing initiatives.
- Act as a clinical resource to FEP internal staff regarding medication therapy.
- Evaluate medication related problems such as adverse events, therapeutic duplication, adherence to therapy, polypharmacy, and untreated disease or conditions.
- Analyzes, documents, and reports member outreach and intervention performance results as required by the FEP Medication Therapy Management Program (MTM Program).
- Provide education and training on the appropriate use of medications to monitor and evaluate patient’s response to therapy.
- Document all interventions via a medication related action plan or care plan (CP). The care plan is the course of action to achieve the specified health goals.
- Support and resolve pharmacy related member specific benefit issues.
- Utilize prescription and medical claim data to generate clinical recommendations according to Medication Therapy Management and Retrospective Drug Utilization Review program and protocols.
- Provide clinical recommendations pertaining to, but not limited to, gaps in care, high risk medications, compliance and adherence, drug interactions, therapeutic substitution, and generic substitution.
- Utilize client formulary information and member specific benefits to guide appropriate medication recommendations.
- Maintain awareness of current and emerging clinical trends including but not limited to specialty practice, diseases, published literature and medication therapies for specific patient populations to educate clinical team, physicians and other prescribers.
- Actively participate with cross functional team meetings to improve clinical programs, enhance processes and share clinical information.
- Maintain effective working relationships to ensure teamwork in achieving corporate goals.
- Participate in quality initiatives; including functions that support audits, reporting, evaluation of quality opportunities and concerns, and creation and implementation of corrective actions as requested.
- Coordinate activities between multiple divisions to achieve desired results.
- 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.
- Travel may be required.
- Perform all other duties as assigned.
Required Job Skills
- Proficient in critical literature evaluation skills, including evidence-based medicine principles
- Excellent problem-solving skills
- Strong written and verbal communications.
- Strong PC proficiency.
- Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones.
- Strong skill in word processing, spreadsheet and database software.
Required Professional Competencies
- Flexible skills in an operationally changing environment, with drive for results based on planned objectives.
- Strong customer service skills.
- Interpersonal skills that allow for harmonious relationships with providers, members and coworkers.
- Recognize strategic opportunities and use data to make timely and sound decisions.
- Flexibility and willingness to adjust to shifting demands/priorities.
Required Leadership Experience and Competencies
- High standard of performance while pursuing aggressive goals
- Ability to lead by example
Preferred Job Skills
- 1 year experience with drug therapy
- 1 year experience with HEDIS or population health
- 1 year experience in quality improvement
Preferred Professional Competencies
Preferred Leadership Experience and Competencies
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.
Imagine doing life-changing work and helping more than one million Arizonans live healthier and longer lives. That’s the kind of satisfaction you’ll find when you work here. Our exceptional teams in Phoenix, Tucson, Chandler, and Flagstaff have been transforming healthcare for more than 80 years. Explore what's possible with a career at Blue Cross® BlueShield® of Arizona