Clinical Pharmacist Reviewer — Managed Care

Blue Cross Blue Shield of Massachusetts; Hingham (MA); On-site; USD 118,000 - 147,000; Full time

Benefits offered by this job

Variable pay

Medical/dental/vision insurance

401(k) plan

Paid time off

Job summary

Blue Cross Blue Shield of Massachusetts is seeking a Clinical Pharmacist Reviewer to evaluate formulary exceptions, prior authorizations, and quantity limit exceptions for multiple programs including Retail Pharmacy and Medicare Advantage Part D. The role follows a Saturday 8am-4pm shift with four weekdays as well.

The position requires a MA-licensed pharmacist, with strong communication, teamwork, and analytical abilities.

Qualifications

• Licensed pharmacist in the state of Massachusetts.
• Graduate study in business, public health or health policy favored.
• Experience supervising technical support staff desirable.
• Experience in managed care setting required.
• Proficiency with standard office software and database tools.

Responsibilities

• Review prior authorization and formulary exceptions.
• Support day-to-day approvals and denials to stay compliant.
• Assist with Medicare Part D and Home Infusion Therapy programs.
• Collaborate with clinical and non-clinical teams; assist training.
• Develop drug utilization programs and new clinical opportunities.
• Lead special projects and provide training for staff.
• Create drug information and support for customers.
• Resolve issues raised by MAPS, IT, and PBM teams.
• Communicate program initiatives with Clinical Pharmacy.
• Identify workflow efficiencies and cost-saving opportunities.

Skills

Communication skills

Interpersonal skills

Organizational skills

Analytical skills

Teamwork

Results oriented

Education

Pharmacist degree

Public health background

Tools

Office suite

Relational databases

Job description

Blue Cross Blue Shield of Massachusetts is seeking a Clinical Pharmacist Reviewer to evaluate formulary exceptions, prior authorizations, and quantity limit exceptions for multiple programs including Retail Pharmacy and Medicare Advantage Part D. The role follows a Saturday 8am-4pm shift with four weekdays as well.

The position requires a MA-licensed pharmacist, with strong communication, teamwork, and analytical abilities.