Clinical Pharmacist

Blue Cross & Blue Shield of Rhode Island; United States; Hybrid; USD 117,000 - 187,000; Full time

Benefits offered by this job

Remote work options

Tuition reimbursement

Paid time off

Job summary

Blue Cross & Blue Shield of Rhode Island is seeking a Pharmacist to act as an expert on clinical pharmacy issues, supporting pharmacy program management and the development of cost-effective pharmacy programs. You will respond to internal questions about plan coverage and policy for pharmaceuticals and research appropriate therapies.

The role requires a Rhode Island pharmacy license, knowledge of formularies and Medicare Stars, and collaboration with physicians and internal teams to ensure

Qualifications

• 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.

Responsibilities

• 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.

Skills

Analytical

Communication

Presentation

Interpersonal

Healthcare plans

Cost containment

Utilization review

Pharmacy benefits

Regulatory knowledge

Medicare Stars

Education

Bachelor's degree in related field

Job description

Pay Range

Pay Range: $116,900.00 - $187,100.00

Please email [e-mail] if you are a candidate seeking a reasonable accommodation for the application and/or interview process.

Company Culture

At BCBSRI, our greatest resource is our people. We come from varying backgrounds, different cultures, and unique experiences. We are hard‑working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do—not just for our members, but for our employees as well. We recognize that to do your best work, you have to be your best self. It’s why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student‑loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well‑being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees. Our culture is one of belonging. We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you’re at in the organization, you’re an integral part of our team and your input, thoughts, and ideas are valued. Join others who value a workplace for all. We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders. We’re dedicated to serving Rhode Islanders. Our focus extends beyond providing access to high‑quality, affordable, and equitable care. To further improve the health and well‑being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work literally in communities all across the state—building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer.

Job Overview

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 & Work Setting

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.

Equal Opportunity

BCBSRI is an equal opportunity employer. The law requires an employer to post notices describing the Federal laws. Please visit www.eeoc.gov/know-your-rights-workplace-discrimination-illegal to view the "Know Your Rights" poster.