Pharmacist

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

Ready to help us transform healthcare? Bring your true colors to blue. The Clinical Pharmacist Reviewer reviews formulary exception, prior authorization and quantity limit exception requests from providers via phone and fax for the Retail Pharmacy, Medicare Advantage Part D, Home Infusion Therapy, and Medical Utilization Management benefits. The work schedule for this role is Saturday 8a-4p and four week days.

ROLE RESPONSIBILITIES:

• Participation in Prior Authorization, Formulary Exception, Step Therapy and Quality Care Dosing program implementation and management
• Support Pharmacy Operations analysts in executing day-to-day approvals and denials in order to maintain compliance with all regulatory requirements.
• Support product portfolio, including Medicare Part D which includes rotational weekend and holiday support for timely determinations.
• Support the Home Infusion Therapy, Specialty Pharmacy Network and Medical Utilization Management for pharmaceuticals programs
• Partner with clinical and non-clinical teams for staff training, facilitation of meetings and other ad hoc presentations.
• Participate in the development and design of drug utilization programs and new clinical program opportunities
• Facilitate special projects as assigned
• Develop drug information, training and support to all internal and external customers
• Provide analysis and resolution for issues from MAPS, Health and Medical Management, IT & Ops, PBM account support team and other customer service areas
• Develop strategies for effective communication of program initiatives in partnership with Clinical Pharmacy for internal and external customers
• Identify opportunities for workflow efficiencies and new clinical quality and cost saving programs

EDUCATION AND EXPERIENCE REQUIREMENTS:

• Minimum of professional Registered Pharmacist degree required.
• Graduate study in a business, public health, or health policy field will be favorably considered.
• Unrestricted current and valid license to practice pharmacy in the state of Massachusetts and/or in any other relevant/applicable state
• Experience in direct supervision of technical support staff for clinical and/or service and operational programs is desirable.
• Experience in a managed care setting, either from the provider, the payer, or the PBM side of the industry, is required.
• Proficiency in standard computational office-suite applications, including word-processing and relational database manipulation is required.

SKILL AND BEHAVIORAL COMPETENCIES REQUIRED:

• Excellent written and oral communication skills
• Excellent interpersonal skills
• Strong organizational and time management skills, including ability to work independently and prioritize multiple projects and assignments
• Demonstrated strength in analysis, identification of problems and issue resolution
• Excellent skills in teamwork and team approaches to goal setting and attainment
• Must be results oriented.

Minimum Education Requirements: High school degree or equivalent required unless otherwise noted above

Location Hingham

Time Type Full time

Salary Range: $118,000.00 - $147,290.00 The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability. This job is also eligible for variable pay. We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees. Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant.

We encourage you to bring us your true colors, , your perspectives, and your experiences. It’s in our differences that we will remain relentless in our pursuit to transform healthcare for ALL. As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting our Company Culture page.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.

Voted as the highest in member satisfaction among Massachusetts commercial health plans by JD Power, Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We have been a market leader for over 75 years, and are consistently ranked among the nation's best health plans. Our daily efforts are dedicated to effectively serving our 2.8 million members, and consistently offering security, stability, and peace of mind to both our members and associates.

Our Commitment to You We are committed to investing in your development and providing the necessary resources to enable your success. We are dedicated to creating a refreshing and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path. We take pride in our diverse, community-centric, wellness-focused culture and believe every member of our team deserves to enjoy a positive work-life balance.

Blue Cross Blue Shield of Massachusetts is an Equal Employment Employer - veterans/disability. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or expression, or any other characteristics protected by law. Blue Cross Blue Shield of Massachusetts will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with Blue Cross Blue Shield of Massachusetts's legal duty to furnish information.