DSNP Clinical Pharmacist

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

Benefits offered by this job

D-SNP Pharmacy management experience

Managed care experience

Job summary

Blue Cross and Blue Shield of Rhode Island is seeking a pharmacist to join our clinical pharmacy team. You will serve as an expert on Medicare/Medicaid drug therapy within an interdisciplinary care setting and support program management and case management in developing cost-effective, high-quality pharmacy programs and care plans.

Responsibilities include answering prescription-related questions, coordinating with physicians to optimize therapy, and ensuring formulary adherence and regulatory

Qualifications

• Current and unrestricted Pharmacist license in the State of Rhode Island.
• Three to five years clinical pharmacy experience.
• 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.
• Strong and effective decision-making skills.
• Excellent verbal and written communication skills, with ability to convey complex information.
• Proficiency with Microsoft Suite (Excel, Word, PowerPoint).

Responsibilities

• Act as an expert on Medicare/Medicaid clinical pharmacy issues within the organization and external entities.
• Collaborate with internal departments and physicians to develop care plans to improve outcomes and reduce hospital admissions.
• Ensure medications and services are prescribed and dispensed according to plan designs and state/federal requirements.
• Assist in development of cost-effective pharmacy programs and disease management initiatives.
• Review prescriptions to ensure appropriateness and formulary compliance.
• Assist in physician education interventions.
• Analyze prescription data to identify quality improvement opportunities and advise providers.
• Educate internal departments on plan policies and pharmacy matters.
• Perform other duties as assigned.

Skills

Pharmacy licensure RI

Clinical pharmacy experience

Formulary knowledge

Cost containment

Regulatory knowledge

Health plan benefits knowledge

Decision making

Verbal & written communication

MS Office (Excel, PowerPoint)

Tools

Pharmacy software

Job description

Pay Range:

$116,900.00 - $187,100.00

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.

Why this job matters

Act as an expert on Medicare/Medicaid clinical pharmacy issues as part of an interdisciplinary care team. Provide support to pharmacy program management and case management to assist in the development and maintenance of high quality, cost-effective pharmacy programs and care plans. Respond to internal questions concerning plan coverage and policies for specific pharmaceuticals, research appropriateness of drug therapies, and provide feedback on state regulatory and legislative issues.

What you will do:

• Act as an expert on Medicare/Medicaid 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.
• Collaborate with internal departments and physicians to develop care plans to facilitate high quality outcomes (i.e. drug adherence, appropriate drug utilization, reduced hospital admissions) with a goal of driving quality, cost-effective care.
• Ensure that medications and other pharmaceutical services are prescribed and dispensed according to plan pharmacy benefit designs/policies, professional standards, and state/ federal requirements.
• Assist in the development and maintenance of cost-effective pharmacy programs. Provide insight to pharmacy management services related to disease management initiatives.
• 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 to identify areas of improved quality, and provide recommendations to providers
• 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:

• A combination of education and related work experience.
• Current and unrestricted Pharmacist license in the state of Rhode Island
• Three to five years clinical pharmacy experience.
• 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
• Strong and effective decision-making skills
• Excellent verbal and written communication skills, with ability to convey complex or technical information in an effective manner.
• Proficiency with Microsoft Suite of products (i.e. Excel, Word, PowerPoint, etc.)

The extras:

• D-SNP Pharmacy management experience
• Managed care experience and specific knowledge and training in prescription drugs, pharmacy benefits, utilization review, cost containment strategies, and emerging technology.

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

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.