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.

Supports and reports to (based on level/grade) the Director of Clinical Pharmacy Management.

Facilitates the processes and functions necessary to implement decisions made by BCBSAZ Pharmacy and Therapeutics (P&T) Committee.

REQUIRED QUALIFICATIONS

Required Work Experience

Level 1

1 year Experience in benefit administration (pharmacy or medical)

2 years Experience with reporting tools and data analysis

2 years Demonstrated experience handling confidential information

Level 2

2 years Experience in benefit administration (pharmacy or medical)

3 years Experience with reporting tools and data analysis

3years Demonstrated experience handling confidential information

1 year Demonstrated ability to conduct in-depth research

Level 3

3 years Experience in benefit administration (pharmacy or medical)

5 years Experience with reporting tools and data analysis

5 years Demonstrated experience handling confidential information

2 years Demonstrated ability to conduct in-depth research

Required Education

  • High-School Diploma or GED or above in general field of study (applies to all levels)

Required Licenses

  • N/A

Required Certifications

  • N/A

PREFERRED QUALIFICATIONS

Level 1

2 years Experience in benefit administration (pharmacy or medical)

2 years Experience with BCBSAZ claims Software/Systems

Level 2

4 years Experience in benefit administration (pharmacy or medical)

4 years Experience with BCBSAZ claims Software/Systems

1 year Participated on a committee

1 year Demonstrated experience with a Lead role in coordination of projects

1 year Demonstrated experience with interpreting URAC accreditation standards

1 year Demonstrated experience with audits and interviews

Level 3

6 years Experience in benefit administration (pharmacy or medical)

6 years Experience with BCBSAZ claims Software/Systems

3 years Participated on a committee

3 years Demonstrated experience with a Lead role in coordination of projects

3 years Demonstrated experience with interpreting URAC accreditation standards

3 years Demonstrated experience with audits and interviews

3 years in pharmacy or medical field



Preferred Education

  • Associate’s degree or above in general studies, healthcare, or related field

Preferred Licenses

  • Certified Pharmacy Technician (CPhT)

Preferred Certifications

  • N/A

LEVEL 1 - PERFORMS JOB FUNCTIONS UNDER CLOSE SUPERVISION BY SPECIALIST OR PEER REVIEW
  • Prepare documents for P&T Committee review.
  • Prepare meeting minutes.
  • Communicate and facilitate decisions made by the P&T Committee to team members within Clinical Therapeutics.
  • Identify and communicate claim system issues effectively to Prescription Benefits Analysts.
  • Draft coverage guidelines.
  • Provide support to other team members when necessary.
 

LEVEL 2 - PERFORMS JOB FUNCTIONS WITH MINIMAL SUPERVISION BY SPECIALIST OR PEER REVIEW

  • Perform Level 1 job functions with minimal supervision.
  • Present documents for P&T Committee review.
  • Support maintenance and coordinate review of coverage guidelines.
  • Create and maintain new and existing policies and desk level documents.
  • Participate on special teams and projects as needed.

LEVEL 3 - SUBJECT MATTER EXPERT, PERFORMS JOB FUNCTIONS WITH MINIMAL SUPERVISION

  • Perform Level 1 and Level 2 job functions independently.
  • Prepare P&T Committee meeting agenda.
  • Organize schedule for review of coverage guidelines.
  • Reports P&T activities to oversight committee (Quality Management Committee (QMC)).
  • Assist the Director of Clinical Pharmacy Management with formulary evaluation and appropriate placement of products based on clinical studies and financial impact.
  • Assist the Director of Clinical Pharmacy Management with evaluation of programs offered that provide innovative comparative effectiveness information to improve the shared decision-making by the plan, member, and providers.
  • Serve as a document design specialist for Clinical Therapeutics.

ALL LEVELS

  • Each progressive level includes the ability to perform the essential functions of any lower levels and mentor employees in those levels.
  • 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

  • Intermediate PC proficiency
  • Intermediate skill in use of office equipment, including copiers, fax machines, scanners, and telephones
  • Intermediate skill in word processing, spreadsheet, and database software
  • Intermediate written communication and letter writing skills

Required Professional Competencies

  • Take initiative
  • Flexibility in prioritization of workflow
  • Maintain confidentiality and privacy
  • Establish and maintain working relationships in a collaborative team environment
  • Capable of teaching and confirming proficiency of delegated skills
  • Analytical knowledge necessary to make or advise on moderate to high impact decisions
  • Compose a variety of business correspondence
  • Demonstrate excellent organization and planning skills

Required Leadership Experience and Competencies

  • Make use of employees' skills and abilities to deliver business objectives
  • Use available information to focus the team's activities and identify priorities

PREFERRED COMPETENCIES

Preferred Job Skills

  • Advanced skill in the use of office equipment, including copiers, fax machines, scanners and telephones
  • Advance PC proficiency
  • Advanced word processing, spreadsheet and database software proficiency

Preferred Professional Competencies

  • Perform investigative and analytical research, including location and interpretation of information from a number of data sources
  • Effective interpersonal communication
  • Claim system experience with pharmacy vendor software and/or systems
  • Understand workflow systems to maximize resources and streamline processes for efficiency

Preferred Leadership Experience and Competencies

  • Good communication skills
  • Ability to delegate

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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