Pharmacist, Consultant Jobs

JOB DESCRIPTION
Your Role

The Pharmacy Services Drug Utilization Management team provides efficient and accurate responses to external customer (physicians, office staff, pharmacy providers, members and brokers) and internal team members for all outpatient medical benefit inquires. The Pharmacist, Consultant will report to the Senior Manager of Medical Benefit Drug Utilization. In this role you will support the Blue Shield of California Pharmacy and Therapeutics (P&T) Committee process, and support the clinical components of the Pharmacy Services Drug Utilization Program by ensuring that evidence based clinical decisions of the Blue Shield of California Pharmacy and Therapeutics Committee are implemented operationally in order to support safe, efficacious, and cost-effective prescribing of medications provided under the medical benefit .

Your Work

In this role, you will:

• Support the operational and clinical implementation of medication policies for drugs provided under the medical benefit, for both Commercial, Medicare, and Medi-Cal lines of business
• Operate in compliance with all regulatory and accreditation requirements, and corporate policies and procedures regarding to support access to safe, efficacious, and medically necessary medications
• Provide pharmacist support for the drug prior authorization program by providing clinical expertise to Prior Authorization technician team to ensure review of prior authorization requests within all regulatory required time frames
• Assist in preparing materials for audits and reports; completes projects as assigned
• Provide pharmacist support by providing clinical and operational expertise to ensure review of post claims requests within all regulatory required time frames
• Support peer to peer process and facilitate provider discussion regarding prior authorization denials
• Ensure compliance with various regulatory and quality accreditation requirements around drug utilization management in order to support safe, efficacious, and cost-effective prescribing
• Provide pharmacotherapy expertise for Blue Shield’s pharmacy program by supporting: Pharmacy and Therapeutics Committee, drug formulary, drug prior authorization and utilization review programs, health plan benefit design, member/provider communications related to medication use, and the pharmacy student/residency programs
• Serve as an educational resource to internal and external constituents regarding the Blue Shield drug formulary, medication policies and appropriate drug use

QUALIFICATIONS
Your Knowledge and Experience

• Prior experience in managed care/PBM is preferred
• Requires a Doctor of Pharmacy (PharmD) degree
• Requires working at least one weekend every two months and company holidays as needed to ensure regulatory compliance with prior authorization turn around times
• Requires a currently active and unrestricted California Registered Pharmacist (RPh) license
• Requires excellent oral and written communication skills
• Requires thorough knowledge of therapeutic use of medications
• Requires at least 2 years of experience in clinical pharmacy

Pay Range:

The pay range for this role is: $ 118800.00 to $ 178200.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

ABOUT THE TEAM
Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to diversity, equity, and inclusion combines a focus on our people, processes, and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area’s top companies in volunteering & giving, and one of the world’s most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in – join us!

Our Values:

• Courageous . We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
• Honest . We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human . We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.

From the earliest days of the pandemic, Blue Shield of California has been unyielding in our commitment to putting the health and safety of our people, our members and our communities first. As a health care company, Blue Shield requires all employees to be up to date with COVID-19 vaccination prior to start date as a condition of employment. Blue Shield will consider requests for medical or religious accommodation to this vaccination requirement prior to your start date.

The definition of "up to date with your COVID-19 vaccine" is when you have received all doses in the primary series and one booster when eligible. If you are unable to be up to date with your COVID-19 vaccine by your start date, your start date will need to be postponed and you will have 30 days to remedy. If you cannot fulfill the requirement nor obtain an accommodation within 30 days, your offer will be rescinded.