Pay Range:$116,900.00 - $187,100.00
Please email if you are a candidate seeking a reasonable accommodation for the application and/or interview process.
Why this job matters:Act as an expert on clinical pharmacy issues. Provide support to pharmacy program management and assist in the development and maintenance of cost-effective pharmacy programs. Respond to internal questions concerning plan coverage and policies for specific pharmaceuticals and research appropriateness of drug therapies.
What you will do:- Act as an expert on 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.
- Ensure that prescribed medications and other pharmaceutical services are prescribed and dispensed according to plan pharmacy benefit designs and policies, professional standards, and state and federal requirements.
- Assist in the development and maintenance of cost effective pharmacy programs. Provide insight to pharmacy management services related to disease management initiatives.
- Collaborate with internal departments and physicians to improve prescription and clinical practices to ensure high quality, cost-effective care.
- 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, identify areas for improvement, and provide recommendations to physicians.
- Educate internal departments on plan policies, benefits, and any other administrative matters related to pharmacy.
- Perform other duties as assigned.
What you need to succeed:- Bachelor's degree in related field
- Valid Pharmacist license in the state of Rhode
- Experience with Medication Therapy Management and Medicare Stars program
- 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
- Analytical skills
- Strong communication and presentation skills.
- Interpersonal skills
The extras:- Three to five years experience in managed care
- Pharmacy management experience
- Specific knowledge and training in prescription drugs, pharmacy benefits, utilization review, cost containment strategies, and emerging technology.
Location:BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:
- In-office: onsite 5 days per week
- Hybrid: onsite 2-4 days per week
- Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia
