Pharmacist-PBM

Capital Blue Cross; Harrisburg (Dauphin County); Hybrid; USD 110,000 - 150,000; Full time

Benefits offered by this job

Comprehensive benefits package

Retirement plan

Paid time off

Tuition reimbursement

Hybrid work arrangement

Professional development opportunities

Job summary

Capital Blue Cross in Harrisburg, PA seeks a senior pharmacist leader to develop and evaluate pharmacy clinical initiatives and utilization management programs, ensuring cost-effective, high-quality pharmaceutical services for plan members.

The role oversees the formulary program, collaborates with PBM partners, and supports committees such as Pharmacy and Therapeutics, Medical Policy, and Quality Management. Strong clinical, analytical, and communication skills are essential.

Qualifications

• Pharmacy degree and PA license required.
• Advanced degree preferred (MS or PharmD).
• Experience with formulary systems and NCQA/Medicare Part D preferred.

Responsibilities

• Manage formulary and P&T committee activities.
• Oversee PBM vendor clinical services.
• Lead specialty pharmacologic management programs.
• Develop clinical criteria, policies, and procedures.
• Provide clinical information support to committees.
• Ensure regulatory compliance including Medicare Part D and NCQA.
• Staff supervision.

Job description

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”

This position is responsible for the development, maintenance, and evaluation of pharmacy clinical initiatives and utilization management programs to assure a consistently cost-effective and quality pharmaceutical services and benefits for plan members. The incumbent manages the drug formulary program as well as clinical activities and oversees the clinical program administration by the pharmacy benefit management (PBM) company. The incumbent also serves as a resource to providing clinical support to committees and workgroups such as Pharmacy and Therapeutics Committee, Medical Policy Committee, Quality Management Committee, Delegation Oversight, and HEDIS/NCQA. The incumbent possesses good clinical/analytical skills and sound decision-making capabilities to identify opportunities/risks and propose benefit program quality/utilization management strategies accordingly. Strong interpersonal and excellent communication skills are essential due to interaction with various members of the medical profession, managed care clients, and external organizations.

Duties and Responsibilities:

• Formulary management including drug evaluation, P&T Committee, and related physician and member collaterals
• Pharmaceutical utilization and trend management via pharmacy clinical initiatives
• PBM vendor clinical services and programs oversight
• Specialty pharmaceutical management
• Pharmacy clinical and utilization management criteria, protocol, policies, and procedure development
• Provide clinical and drug information support
• Maintain regulatory including Medicare Part D, and accreditation compliance
• Develop member and provider educational programs
• Conduct presentation and training
• Maintain provider and pharmaceutical industry/drug manufacturer relations.
• Staff supervision

Skills:

• Strong interpersonal and team skills with ability to work and interact externally and internally. Ability to communicate effectively with varied audiences, including ability to lead meetings, develop teamwork, and deliver verbal presentations. Ability to take direction from various levels of staff and perform project work with minimal supervision.
• Strong clinical/analytical skills and decision-making capabilities required. Strong interpersonal and excellent communication skills required. Ability to assess utilization data to identity new opportunities.

Knowledge:

• Managed care knowledge and experience preferred. In-depth knowledge of drug formulary systems and drug evaluation process. Broad knowledge of outpatient drug benefit and utilization management programs.
• Knowledge of pharmacy claims processing along with applicable state/federal laws.
• Knowledge and experience with Medicare Part D and NCQA accreditation preferred. Knowledge and experience with therapy medication and disease state management.
• Possess working knowledge of medical and pharmacy data integration to close gap in care and facilitate greater care coordination.

Experience:

• Experience in developing pharmacy clinical protocol, policies, and procedures. Experience in design/deployment of programs to increase quality of care and decrease costs.

Education and Certifications:

• Pharmacy degree and current Pennsylvania pharmacy license required. Advanced pharmacy degree (Masters or Pharm.D.) preferred.

Location:

• This position is classified hybrid, which requires onsite work on Tuesdays and Wednesdays.
• Working environment includes typical office conditions.

Physical Demands:

• While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see.
• The employee must be able to work over 40 hours per week.
• The employee must occasionally lift and/or move up to 5 pounds.
• Sedentary work involving significant periods of sitting, talking, hearing, keying and performing repetitive motions. Work requires visual acuity to perform close inspection of written and computer generated documents as well as a PC monitor.

Other:

• Performs other related duties and assignments as directed.
• Travel less than 1%. Occasional overnight travel and travel between CBC locations.

Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.