Medicare/Medicaid Clinical Pharmacist – Remote or Hybrid

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

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