Act as an expert on Medicare/Medicaid clinical pharmacy
issues as part of an interdisciplinary care team. Provide support to pharmacy
program management and case management to assist in the development and
maintenance of high quality, cost-effective pharmacy programs and care
plans. Respond to internal questions
concerning plan coverage and policies for specific pharmaceuticals, research
appropriateness of drug therapies, and provide feedback on state regulatory and
ESSENTIAL JOB FUNCTIONS:
- Act as an expert on Medicare/Medicaid clinical pharmacy issues within the organization and to external companies including the company Pharmacy Benefit Manager. Respond to clinical questions regarding prescription medications including those utilized by members.
- Collaborate with internal departments and physicians to develop care plans to facilitate high quality outcomes (i.e. drug adherence, appropriate drug utilization, reduced hospital admissions) with a goal of driving quality, cost-effective care.
- Ensure that medications and other pharmaceutical services are prescribed and dispensed according to plan pharmacy benefit designs/policies, professional standards, and state/ federal requirements.
- Assist in the development and maintenance of cost-effective pharmacy programs. Provide insight to pharmacy management services related to disease management initiatives.
- Review prescriptions issued by physician or other authorized prescriber to ensure appropriateness of therapy and compliance with the formulary.
- Assist in the development of physician educational interventions.
- Analyze prescription data to identify areas of improved quality, and provide recommendations to providers
- Educate internal departments on plan policies, benefits, and any other administrative matters related to pharmacy.
- Perform other duties as assigned.
Minimum Education and Experience:
- A combination of education and related work experience.
- Current and unrestricted Pharmacist license in the state of Rhode Island
- Three to five years clinical pharmacy experience.
Preferred Education, Additional Qualifications and Experience:
- D-SNP Pharmacy management experience
- Managed care experience and specific knowledge and training in prescription drugs, pharmacy benefits, utilization review, cost containment strategies, and emerging technology.
Required Knowledge, Skills, and/or Abilities:
- Knowledge of formularies, rebate contracts, and pharmacy benefit design
- Knowledge of cost containment and utilization review strategies
- Knowledge of state and federal laws as applicable to the health insurance industry
- Knowledge of health care plans and benefits
- Strong analytical skills
- Strong and effective decision-making skills
- Excellent verbal and written communication skills, with ability to convey complex or technical information in an effective manner.
- Proficiency with Microsoft Suite of products (i.e. Excel, Word, PowerPoint, etc.)
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- Pay Type Salary
- Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, Rhode Island, United States of America