Hybrid Clinical Pharmacist – Utilization & Policy Expert

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

Benefits offered by this job

Tuition reimbursement

Club Blue gym access

Onsite Green Leaf Grill restaurants

Wellness incentives

Job summary

Arkansas Blue Cross and Blue Shield is seeking a Clinical Pharmacist to report to Pharmacy Leadership and collaborate with medical directors and enterprise personnel. The role may focus on Care Management, Utilization Management, or other lines of business.

The hybrid position in Little Rock, AR requires a minimum of three days in office weekly and offers the opportunity to contribute to pharmacy program best practices and reimbursement strategies.

Qualifications

• Bachelors degree in Pharmacy from an accredited college of pharmacy.
• Holds an active and current, unrestricted pharmacy license in states where duties are performed.
• Minimum three (3) years of pharmacy practice experience; managed pharmacy care and drug utilization review preferred.

Responsibilities

• Assists in development and supervision of the drug utilization and prior authorization review program.
• Develops and implements pharmacy cost containment strategies for enterprise, regions, and large accounts.
• Drafts pharmaceutical criteria for the enterprise prior authorization program.
• Maintains up-to-date medication knowledge and collaborates with Medical Directors and leadership as SME.
• May conduct second level reviews for medical and pharmacy benefit prior-authorizations and medical necessity reviews.
• Ensures alignment of medical policies and claims processing for utilization management.
• Prepares and presents reports on utilization and cost trends for lines of business and large accounts.
• Leads pharmacy reimbursement, claims processing policies, and vendor selection insights.
• Reviews coverage across lines of business to determine review type and coordinates with providers and staff.
• Serves as liaison to pharmacists, professional organizations, internal committees, and other providers on pharmacy issues.
• Supports initiatives for member, provider, and client satisfaction.
• Uses clinical knowledge and critical thinking to interpret criteria and approve reviews within case management.
• Communicates pharmacy and medical benefit knowledge to Care Management nurses, social workers, and medical directors.
• Ensures timely medication access for members and minimizes delays in treatment.

Skills

Coaching Others

Conflict Resolution

Continuous Learning

Critical Thinking

Employee Engagement

Evaluating Information

Interpersonal Communication

Interpersonal Relationships

Management Techniques

Monitor Processes

Oral Communications

Problem Sensitivity

Researching

Service Oriented

Task Delegation

Time Management

Written Communication

Education

Bachelor's degree in Pharmacy

Job description

Arkansas Blue Cross and Blue Shield is seeking a Clinical Pharmacist to report to Pharmacy Leadership and collaborate with medical directors and enterprise personnel. The role may focus on Care Management, Utilization Management, or other lines of business.

The hybrid position in Little Rock, AR requires a minimum of three days in office weekly and offers the opportunity to contribute to pharmacy program best practices and reimbursement strategies.