Clinical Pharmacist

01 USAble Mutual Insurance Company; Little Rock (AR); Hybrid; USD 125,000 - 159,000; Full time

Benefits offered by this job

Tuition reimbursement

Club Blue gym access

Onsite Green Leaf Grill restaurants

Wellness incentives

Job summary

Arkansas Blue Cross and Blue Shield is seeking a Clinical Pharmacist to report to Pharmacy Leadership and collaborate with medical directors and enterprise personnel. The role may focus on Care Management, Utilization Management, or other lines of business.

The hybrid position in Little Rock, AR requires a minimum of three days in office weekly and offers the opportunity to contribute to pharmacy program best practices and reimbursement strategies.

Qualifications

• Bachelors degree in Pharmacy from an accredited college of pharmacy.
• Holds an active and current, unrestricted pharmacy license in states where duties are performed.
• Minimum three (3) years of pharmacy practice experience; managed pharmacy care and drug utilization review preferred.

Responsibilities

• Assists in development and supervision of the drug utilization and prior authorization review program.
• Develops and implements pharmacy cost containment strategies for enterprise, regions, and large accounts.
• Drafts pharmaceutical criteria for the enterprise prior authorization program.
• Maintains up-to-date medication knowledge and collaborates with Medical Directors and leadership as SME.
• May conduct second level reviews for medical and pharmacy benefit prior-authorizations and medical necessity reviews.
• Ensures alignment of medical policies and claims processing for utilization management.
• Prepares and presents reports on utilization and cost trends for lines of business and large accounts.
• Leads pharmacy reimbursement, claims processing policies, and vendor selection insights.
• Reviews coverage across lines of business to determine review type and coordinates with providers and staff.
• Serves as liaison to pharmacists, professional organizations, internal committees, and other providers on pharmacy issues.
• Supports initiatives for member, provider, and client satisfaction.
• Uses clinical knowledge and critical thinking to interpret criteria and approve reviews within case management.
• Communicates pharmacy and medical benefit knowledge to Care Management nurses, social workers, and medical directors.
• Ensures timely medication access for members and minimizes delays in treatment.

Skills

Coaching Others

Conflict Resolution

Continuous Learning

Critical Thinking

Employee Engagement

Evaluating Information

Interpersonal Communication

Interpersonal Relationships

Management Techniques

Monitor Processes

Oral Communications

Problem Sensitivity

Researching

Service Oriented

Task Delegation

Time Management

Written Communication

Education

Bachelor's degree in Pharmacy

Job description

Job Summary

The Clinical Pharmacist will report to and operate under the direction of Pharmacy Leadership and will also be expected to work cooperatively and sometimes independently with all medical directors and enterprise personnel. This position may be assigned to a specific scope and/or line of business (Care Management, Utilization Management, etc.).

Requirements

• EDUCATION Bachelor's degree in Pharmacy from an accredited college of pharmacy.
• LICENSING/CERTIFICATION Holds an active and current, unrestricted license in pharmacy in the state(s) where job duties are performed required.
• EXPERIENCE & KNOWLEDGE Minimum three (3) years' pharmacy practice experience. Minimum three (3) years' experience in managed pharmacy care and drug utilization review preferred. Preference will be given to individuals who have one (1) or more years of experience in medical pharmacy utilization management.

Location

This is a hybrid role in our Little Rock, AR, location, requiring a minimum of three days in office weekly.

Skills

• Coaching Others
• Conflict Resolution
• Continuous Learning
• Critical Thinking
• Employee Engagement Strategies
• Evaluating Information
• Interpersonal Communication
• Interpersonal Relationships
• Management Techniques
• Monitor Processes, Materials, or Surroundings
• Oral Communications
• Problem Sensitivity
• Researching
• Service Oriented
• Task Delegation
• Time Management
• Written Communication

Responsibilities

• Assists in development and supervises the drug utilization and prior authorization review program.
• Develops and implements pharmacy cost containment strategies tailored to the specific situations and patterns of the enterprise, specific regions, and large accounts.
• Drafts pharmaceutical criteria and performs other activities in support of the enterprise prior authorization program.
• Keeps up-to-date on medication information, contributing to the identification of pharmacy program best practices, collaborating with Medical Directors, leadership, and clinical department as a subject matter expert (SME).
• May be responsible for conducting the second level review for medical and pharmacy benefit medication prior-authorizations, exceptions, and medical necessity reviews submitted to the plan.
• May be responsible for ensuring appropriate alignment of medical policies and configuration for claims processing and utilization management.
• Performs other duties as assigned.
• Prepares and presents reports, data and analyses on the utilization and cost trends for enterprise lines of business, specific regions, and large accounts.
• Provides leadership and advice on developing and implementing pharmacy reimbursement, claims processing policies and procedures, and pharmacy vendor selection.
• Reviews and interprets coverage across assigned line(s) of business to determine what type of review is required and works with requesting providers, corporate medical directors, and other internal staff, as appropriate, in determining whether a specific case presentation meets the criteria for approval according to the specific coverage criteria.
• Serves as a liaison to individual pharmacists, professional pharmacy organizations, internal committees, case management, medical management, and other providers on pharmacy issues.
• Supports pharmacy initiatives for member, provider, and client satisfaction.
• Uses clinical knowledge and independent critical thinking skills towards interpreting criteria, policies, and procedures to make determinations on prior approval reviews and retrospective reviews and/or pharmacy consultations within case management.
• Uses knowledge of the pharmacy and/or medical benefit to communicate with, and provide recommendations to Care Management nurses, social workers, and medical directors.
• Uses knowledge of the pharmacy and/or medical benefit to ensure our members receive their medications in a timely fashion, avoiding delays in treatment.

Certifications

Pharmacist License - Arkansas State Board of Pharmacy

Hiring Range $125,000.00 - $158,550.00

Security Requirements

This position is identified as level three (3).

This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.

Employment Type

Regular ADA Requirements 1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.

Why?

Arkansas Blue Cross is consistently ranked as one of the best places to work in Central Arkansas. We Love our Employees At Arkansas Blue Cross, we care about the health, wellness, and education of our employees. We offer many great incentives such as:

• Tuition reimbursement.
• Club Blue, a free, onsite gym to encourage exercise.
• Green Leaf Grill and Green Leaf Grill Express, onsite restaurants in Little Rock that promote healthy eating.
• Incentives for wellness education and exercise

We Love our Culture

The average tenure is 10 years with hundreds of employees having been here 15 years or longer. Our inclusive culture brings employees together to connect while celebrating our differences.

We Love our Community

Our employees often volunteer within their communities, at charity events, walks and runs, schools and nonprofits. When disasters strike, our employees help wherever they are needed. It’s just another way we show that Blue cares.