Pharmacist, Consultant

Blue Shield of CA; Lodi (CA); Hybrid; USD 140,000 - 190,000; Full time

Job summary

Blue Shield of California is seeking a Pharmacist-Consultant to join the Pharmacy Benefit Prior Authorization team, ensuring evidence-based decisions for outpatient pharmacy coverage. This role supports the P&T committee and reports to the DUR Pharmacist Manager.

Required are a PharmD, active CA RPh license, 2+ years of clinical pharmacy experience, and PA experience; familiarity with formulary policies is essential. Hybrid work model with occasional office attendance.

Qualifications

• Requires PharmD degree.
• Requires active, unrestricted California Pharmacist license (RPh).
• Requires at least 2 years of clinical pharmacy experience.
• Requires experience in a health plan, managed care, or academic setting.
• 1 year of prior authorization experience is required.
• Experience with formulary and medication policies is required.

Responsibilities

• Review authorization requests for outpatient pharmacy coverage.
• Support the PA team to implement evidence-based decisions.
• Contribute to formulary policies and medication safety initiatives.
• Report to the DUR Pharmacist Manager.

Skills

Communication skills

Pharmacology knowledge

Education

Doctor of Pharmacy (PharmD)

Job description

The Prior Authorization (PA) team utilizes clinical knowledge to review authorization requests for coverage under the outpatient pharmacy benefit. The Pharmacist-Consultant will work as part of the pharmacy benefit Prior Authorization (PA) team to support the Blue Shield of California (BSC) Pharmacy and Therapeutics Committee (P&T) by ensuring that evidence based clinical decisions are implemented appropriately to provide a high-quality and cost-effective pharmacy benefit. The Pharmacist- Consultant (Drug Utilization Review Pharmacist) will report to the Drug Utilization Review (DUR) Pharmacist Manager.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

Requires a Doctor of Pharmacy (PharmD) degree

Requires a currently active and unrestricted California Registered Pharmacist (RPh) license

Requires at least 2 years of experience in clinical pharmacy

Requires experience working at a health plan (managed care, government payer, or academic)

1 year of prior authorization experience required

Experience working with formulary and medication policies required

Excellent oral and written communication skills

Thorough knowledge of therapeutic use of medications

Hybrid Virtual Work

This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.