Clinical Pharmacist - Remote/Hybrid Impact Leader

Blue Cross & Blue Shield of Rhode Island; Providence (RI); Hybrid; USD 117,000 - 187,000; Full time

Benefits offered by this job

Tuition reimbursement

Student-loan repayment assistance

Health, dental, and vision insurance

Bonuses and investment plans

Remote and hybrid work options

Job summary

Blue Cross & Blue Shield of Rhode Island is seeking a pharmacist with expertise in clinical pharmacy to support program management and cost-effective drug initiatives. You will respond to internal questions on plan coverage and drug therapies while ensuring compliance with formulary and regulatory requirements.

The role involves collaboration with physicians and departments to improve prescribing practices and patient outcomes.

Qualifications

• Bachelor’s degree in related field.
• Valid Pharmacist license in Rhode Island.
• 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 skills

Strong communication

Interpersonal skills

Medication Therapy Management

Medicare Stars program

Formulary knowledge

Cost containment

Utilization review

Education

Bachelor’s degree in related field

Rhode Island Pharmacist license

Job description

Blue Cross & Blue Shield of Rhode Island is seeking a pharmacist with expertise in clinical pharmacy to support program management and cost-effective drug initiatives. You will respond to internal questions on plan coverage and drug therapies while ensuring compliance with formulary and regulatory requirements.

The role involves collaboration with physicians and departments to improve prescribing practices and patient outcomes.