Clinical Pharmacist Reviewer: Managed Care & Formularies

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

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

401(k)

Job summary

Blue Cross Blue Shield of Massachusetts is seeking a Clinical Pharmacist Reviewer to assess formulary exceptions, prior authorizations, and quantity limit requests for Retail Pharmacy, Medicare Part D and related programs.

The role requires a Massachusetts-licensed pharmacist with strong communication, analytical skills and the ability to work across teams. Location: Hingham; typical schedule includes weekend coverage and four weekdays, with a full benefits package.

Qualifications

• Professional Registered Pharmacist degree required.
• Graduate study in business, public health, or health policy favorable.
• Unrestricted license to practice pharmacy in MA and/or applicable states.

Responsibilities

• Review formulary exceptions, prior authorization and qty limit exception requests from providers.
• Support Pharmacy Operations in day-to-day approvals/denials to stay compliant.
• Provide training and support for internal/external customers and cross-functional teams.

Skills

Excellent written and oral comms

Interpersonal skills

Organizational skills

Analytical/problem solving

Teamwork

Results oriented

Education

Registered Pharmacist degree

Graduate study in business/health policy/public health

Massachusetts license to practice pharmacy

Job description

Blue Cross Blue Shield of Massachusetts is seeking a Clinical Pharmacist Reviewer to assess formulary exceptions, prior authorizations, and quantity limit requests for Retail Pharmacy, Medicare Part D and related programs.

The role requires a Massachusetts-licensed pharmacist with strong communication, analytical skills and the ability to work across teams. Location: Hingham; typical schedule includes weekend coverage and four weekdays, with a full benefits package.