Job Description

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.

This position acts as a pharmacy Star Rating resource for network physicians, health plan members, medical services, care management, and member service staffs as well as other internal partners. Serves as a pharmacy quality improvement educator and training resource to network providers and plan members.

  • Provides and assists with the management of pharmacy services to Medicare health plan members that is consistent with acceptable standards of pharmacy practice and CMS Medicare Part D regulations and guidance.
  • Assists in defining, implementing and managing Medicare health plan pharmacy programs that improve pharmacy related Star rating metrics.
  • Directly interfaces with Medicare members, and network providers concerning pharmacy issues and programs. This includes quantifiable success metrics. Attend and back up, when needed, at Leadership meetings. 
  • Produces pharmacy utilization reports as well as clinical quality and economic data to the health plan to assist in pharmacy benefit utilization analysis that support our value based contracts.
  • Conducts audits and produces reports that can be utilized by the care management, quality and compliance departments to evidence quality pharmacy services and meets Medicare requirements.
  • Applies the principles of continuous quality improvement consistent with job expectations. Incorporates quality improvement principles into other activities and projects (i.e. data collection, documentation). Develops criteria for drug use evaluations, medication use indicators and disease-based evaluations.
  • May be assigned to create data extracts of the pharmacy claims system and support ad hoc report requirements for health plan pharmacy utilization management and audit functions.
  • May require off-site travel.
  • 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 our core and leader behaviors each and every day.
  • The position requires a full-time work schedule and does not support work from home.  Full-time is defined as working at least 40 hours per week, plus any overtime as requested or needed to perform job responsibilities.

Perform all other duties as assigned.

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.

Skills / Requirements

  1. Required Work Experience
    • Managed care/health plan and/or pharmacy benefits experience.
  1. Required Education
    • Degree in Pharmacy (advanced degree preferred) from an accredited College of Pharmacy
  1. Required Licenses
    • Pharmacy licensure in state worked.
  1. Required Certifications
    • N/A

PREFERRED QUALIFICATIONS

  1. Preferred Work Experience
    • Medicare Part D experience
  1. Required Job Skills
    • Requires extensive sitting with periodic standing and walking.
    • May be required to lift up to 20 pounds.
    • Requires significant use of personal computer, phone and general office equipment.
    • Needs adequate visual acuity, ability to grasp and handle objects.
    • Needs ability to communicate effectively through reading, writing, and speaking in person or on telephone.
 

 

  1. Required Professional Competencies
    • N/A
  1. Required Leadership Experience and Competencies
    • N/A
 

PREFERRED COMPETENCIES

  1. Preferred Job Skills
    • Advanced skill in use of office equipment, including copiers, fax machines, scanner and telephones
    • Advanced PC proficiency
    • Advanced proficiency in spreadsheet, database and word processing software
    • Expert knowledge of operating systems, i.e. Windows and systems networking and communication techniques
    • Proficiency with PC based productivity tools required. Needs analytical ability to support decision making; organizational ability to manage multiple tasks and projects by established deadlines.
 
  1. Preferred Professional Competencies
    • Requires exceptional human relations and verbal/written communication skills and the ability to work collaboratively with community based practitioners and the senior population. An understanding of the interrelationships of health plan pharmacy components, members, and providers is required.
 

Application Instructions

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