Clinical Pharmacist

Blue Cross & Blue Shield of Mississippi; Flowood (MS); On-site; USD 105,000 - 125,000; Full time

Job summary

Blue Cross & Blue Shield of Mississippi is seeking Clinical Pharmacists to review Prescription Drug Prior Authorization Requests and Appeals for coverage and medical necessity. The role focuses on patient care and medication optimization rather than routine dispensing, collaborating with the Chief Medical Director to guide benefit design decisions.

Two positions are available. Requirements include PharmD, Mississippi license, and 1+ year in a fast-paced setting, with strong clinical knowledge

Qualifications

• PharmD required; residency preferred.
• Current Mississippi Pharmacist license or intent to obtain.
• 1+ year experience in a fast-paced retail/pharmacy setting.
• Clinical pharmacy knowledge and data interpretation skills.
• Proficiency in Microsoft Office (Word/Excel).
• Strong written and verbal communication across teams.

Responsibilities

• Conduct clinical reviews of Prior Authorization Requests and Appeals.
• Research information to complete comprehensive reviews.
• Make objective determinations based on data and guidelines.
• Consult with Physician Reviewer for final determinations.
• Communicate decisions to providers, pharmacy teams and members.
• Meet quality and production timelines.

Skills

Clinical reviews

Communication with providers

Data interpretation

Multitasking

Healthcare economics understanding

Education

PharmD degree

Mississippi Pharmacist license

Tools

MS Word

MS Excel

Job description

Healthy Careers Start Here

Be part of a vision for a healthier Mississippi as a Clinical Pharmacist.

Our Clinical Pharmacist focuses on best practice patient care and medication optimization rather than routine dispensing or administration. Join our team and start a meaningful career where your work supports better health outcomes for Mississippians every day.

At Blue Cross & Blue Shield of Mississippi, we are seeking Clinical Pharmacists to work in collaboration with the Chief Medical Director to review Prescription Drug Prior Authorization Requests and Appeals for coverage and medical necessity determinations. This Pharmacist also reviews drug database information and drug utilization activity to ensure proper pharmacy benefits administration and makes recommendations for benefit design based on data and trends.

There are currently two positions available.

What You’ll Do

• Conduct clinical reviews of Prescription Drug Prior Authorization Requests and Prescription Drug Appeals against Prescription Drug Benefits, Medical Policy Guidelines, prescribing information and compendia.
• Research and gather necessary information to complete comprehensive reviews.
• Make objective determinations and recommendations based on information, knowledge and experience.
• Consult with Physician Reviewer to make final determinations.
• Communicate decisions to Prescribing Provider, Specialty Pharmacy and Member as appropriate.
• Meet quality and production rates to maintain established timelines.

Job-Specific Requirements

• Doctor of Pharmacy (PharmD) degree. Residency is preferred.
• Current Mississippi Pharmacist license (or intent to get same).
• One year or more experience in a fast-paced general retail pharmacy setting.
• Clinical pharmacy knowledge.
• Understanding basic economic principles and the ability to apply them to the utilization management setting.
• Intermediate proficiency using Microsoft Office, specifically Word and Excel.
• Advanced organizational and multitasking skills with the ability to prioritize competing tasks and perform them with accuracy simultaneously.
• Skilled in using clinical terminology to communicate effectively across interdisciplinary teams, including physicians, nursing staff, and administrative personnel.
• Skilled in detailing analytical processes in written form and clearly articulating the rationale behind complex determinations.
• Ability to work at a high degree of accuracy with information that is confidential in nature.

Preferred Include

• Previously managed care or pharmacy benefits management experience.

Why Join Us

• Purpose-Driven Work: Make a meaningful impact on the Health & Wellness of our Members.
• Healthy Culture: Work in an environment with a focus on your health which allows you to thrive. The walking track, onsite gym and café are just a few of the highlights of the campus.
• Compensation & Benefits: We offer a highly competitive compensation package that includes medical benefits, 401(k), ample paid time off and a schedule that supports true work/life balance

At Blue Cross & Blue Shield of Mississippi, we’re not just about providing health insurance, we are creating a strong, supportive community which encourages every Mississippian to live their healthiest life. This mission requires a talented and motivated team with diverse sets of skills and experiences, aligned with the commitment of a healthy Mississippi. By combining strong financial stewardship with a focus on the Health & Wellness of Mississippians, we invest in programs, partnerships, and innovations which drive quality care, lower costs, and healthier lives.

Blue Cross & Blue Shield of Mississippi is an Equal opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

It’s good to be Blue!

Blue Cross & Blue Shield of Mississippi is an Equal opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We offer a comprehensive benefits package that is worth approximately one-third of the salary compensation. Our benefits program is among the best in the health care field. We are looking for employees who can bring their experience, expertise and dedication to work for our customers.