The clinical pharmacist will review prior authorization requests and perform medication therapy management to improve patient outcomes and reduce costs. They will collaborate with cross-functional teams to provide clinical recommendations and ensure adherence to HEDIS measures and quality initiatives.
Requirements summary
Candidates must hold a Doctor of Pharmacy (Pharm.D) degree and an active, unrestricted pharmacist license in Arizona. A minimum of 3 years of experience in both practicing pharmacy and the managed care field is required.
postgraduate degreeCommunicationHEDISProblem-solvingPatient educationQuality improvementData analysisClinical documentationClinical pharmacyFormulary managementMedication therapy managementPrior authorizationDrug utilization reviewTherapeutic substitutionManaged care pharmacyCritical literature evaluation
Job description
Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.
AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work.
Our positions are classified as hybrid, onsite or remote.
While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements: Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month Onsite: daily onsite requirement based on the essential functions of the job Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building Please note that onsite requirements may change in the future, based on business need, and job responsibilities.
Most employees should expect onsite requirements and at a minimum of once per week.
This position is hybrid within the state of AZ only.
This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.
Purpose of the job Provide utilization and drug interaction of drug therapies to include review of prior authorization requests according to FEP member benefits and coverage criteria.
Perform member specific interventions through provider collaboration and comprehensive medication review with a focus on cost savings, HEDIS measure gap closure, and reduction of readmissions.
Qualifications REQUIRED QUALIFICATIONS Required Work Experience 3 years or more as a practicing pharmacist 3 years or more experience in the managed care pharmacy field Required Education Doctor of Pharmacy (Pharm.D) degree Required Licenses Active, current and unrestricted State of Arizona (a state in the United States) pharmacist license Required Certifications Specialty certification in Medication Therapy Management (may obtain certification within 6 months of job entry) PREFERRED QUALIFICATIONS Preferred Work Experience 5 years or more as a practicing pharmacist 5 years or more of experience in the managed care pharmacy field 2 years of experience with Medicare Part D formulary and utilization management 2 years of experience in performing Medication Therapy Management Preferred Education N/A Preferred Licenses N/A Preferred Certifications N/A ESSENTIAL job functions AND RESPONSIBILITIES Collaborate with FEP Management, FEP Operations, and FEP HEDIS to create clear communication to FEP members and/or network providers on medication therapy recommendations.
Benefits
Health insurance
Work in partnership with FEPDO and Pharmacy Management team.
Regularly collaborate with other plan pharmacy reps and programs.
Collaborate with FEP Management and HEDIS staff for targeted FEP ongoing initiatives.
Act as a clinical resource to FEP internal staff regarding medication therapy.
Evaluate medication related problems such as adverse events, therapeutic duplication, adherence to therapy, polypharmacy, and untreated disease or conditions.
Analyzes, documents, and reports member outreach and intervention performance results as required by the FEP Medication Therapy Management Program (MTM Program).
Provide education and training on the appropriate use of medications to monitor and evaluate patient’s response to therapy.
Document all interventions via a medication related action plan or care plan (CP).
The care plan is the course of action to achieve the specified health goals.
Support and resolve pharmacy related member specific benefit issues.
Utilize prescription and medical claim data to generate clinical recommendations according to Medication Therapy Management and Retrospective Drug Utilization Review program and protocols.
Provide clinical recommendations pertaining to, but not limited to, gaps in care, high risk medications, compliance and adherence, drug interactions, therapeutic substitution, and generic substitution.
Utilize client formulary information and member specific benefits to guide appropriate medication recommendations.
Maintain awareness of current and emerging clinical trends including but not limited to specialty practice, diseases, published literature and medication therapies for specific patient populations to educate clinical team, physicians and other prescribers.
Actively participate with cross functional team meetings to improve clinical programs, enhance processes and share clinical information.
Maintain effective working relationships to ensure teamwork in achieving corporate goals.
Participate in quality initiatives; including functions that support audits, reporting, evaluation of quality opportunities and concerns, and creation and implementation of corrective actions as requested.
Coordinate activities between multiple divisions to achieve desired results.
The position requires a full-time work schedule.
Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
Travel may be required.
Perform all other duties as assigned. competencies REQUIRED COMPETENCIES Required Job Skills Proficient in critical literature evaluation skills, including evidence-based medicine principles Excellent problem-solving skills Strong written and verbal communications.
Strong PC proficiency.
Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones.
Strong skill in word processing, spreadsheet and database software.
Required Professional Competencies Flexible skills in an operationally changing environment, with drive for results based on planned objectives.
Strong customer service skills.
Interpersonal skills that allow for harmonious relationships with providers, members and coworkers.
Recognize strategic opportunities and use data to make timely and sound decisions.
Flexibility and willingness to adjust to shifting demands/priorities.
Required Leadership Experience and Competencies High standard of performance while pursuing aggressive goals Ability to lead by example PREFERRED COMPETENCIES Preferred Job Skills 1 year experience with drug therapy 1 year experience with HEDIS or population health 1 year experience in quality improvement Preferred Professional Competencies N/A Preferred Leadership Experience and Competencies N/A Our Commitment AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona.
For more information on our company, see azblue.com.
If interested in this position, please apply.
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