Clinical Pharmacist - Utilization & Cost Management

Arkansas Blue Cross Blue Shield; Little Rock (AR); Hybrid; USD 125,000 - 159,000; Full time

Job summary

Arkansas Blue Cross Blue Shield is seeking a Clinical Pharmacist in Little Rock, AR. The role reports to Pharmacy Leadership and may work with Medical Directors and enterprise personnel across Care Management and Utilization Management.

A bachelor’s degree in Pharmacy and an active state license are required. Three years of pharmacy practice experience are needed, with preference for experience in managed care and drug utilization review.

Qualifications

• Bachelor’s degree in Pharmacy from an accredited college of pharmacy.
• Active and current, unrestricted license in pharmacy in the state(s) where job duties are performed.
• Minimum three (3) years’ pharmacy practice experience.
• Preference for 1+ years in medical pharmacy utilization management.

Responsibilities

• Assists in development and supervises the drug utilization and prior authorization review program.
• Develops and implements pharmacy cost containment strategies for enterprise, regions, and large accounts.
• Drafts pharmaceutical criteria and supports the enterprise prior authorization program.
• Keeps up-to-date on medication information and shares best practices with Medical Directors and leadership.
• May conduct second level review for medical and pharmacy benefit prior-authorizations and medical necessity reviews.
• Ensures alignment of medical policies and claims processing with utilization management strategies.
• Performs other duties as assigned.
• Prepares and presents reports and analyses on utilization and cost trends for enterprise lines and large accounts.
• Provides leadership on pharmacy reimbursement, claims processing policies, and vendor selection.
• Reviews coverage to determine required review type and collaborates with providers and internal staff.

Skills

Coaching

Conflict Resolution

Critical Thinking

Interpersonal Communication

Time Management

Written Communication

Education

Pharmacy Degree

Job description

Arkansas Blue Cross Blue Shield is seeking a Clinical Pharmacist in Little Rock, AR. The role reports to Pharmacy Leadership and may work with Medical Directors and enterprise personnel across Care Management and Utilization Management.

A bachelor’s degree in Pharmacy and an active state license are required. Three years of pharmacy practice experience are needed, with preference for experience in managed care and drug utilization review.