BlueCross BlueShield of Tennessee Clinical Pharmacist I (Managed Care) in Chattanooga, Tennessee
The Clinical Pharmacist I is responsible for managing various clinical pharmacy programs. The Clinical Pharmacist I will be responsible for reviewing pharmacy related utilization across all lines of business, preparing recommendations for prescribers and members in order to modify prescription utilization and optimize therapeutic outcomes. This position will participate in direct contact with prescribers to present recommendations and function as a contact point for case/disease management staff for pharmacy related issues. This individual will support the utilization review process for case and risk management related to the utilization of pharmaceuticals.
Job Duties & Responsibilities
- Responsible for day to day involvement clinical pharmacy programs including but not limited to medication adherence, medication therapy management (MTM), polypharmacy, controlled substance monitoring and high risk medication monitoring
- Develops and presents clinical evaluations, pipeline surveillance data, formulary reviews and presentations to the corporate P & T Committee upon request
- Assists in preparation for the corporate Pharmacy and Therapeutics (P&T) Committee meetings
- Serves as a clinical resource and drug information specialist to medical, pharmacy, & nursing staff as well as to allied healthcare providers internally and externally
- Reviews and develops pharmaceutical treatment recommendations for case management referrals
- Provides clinical review of medication-related pre-determination requests, drug prior authorizations, pharmacy appeals and member grievances focused on medications.
- Reviews the draft medical policies and provides any recommendations for change to these policies to the Medical Policy staff
- Provides pharmacy-related educational in-services to BCBST nurses as requested
- Responds to prescriber, pharmacy provider, member appeals, grievances and complaints related to the provision of pharmaceutical services within established time periods
- Assists in the development and on-going review of formularies as well the development and maintenance of medial policies related to specialty pharmaceuticals for all lines of business (Commercial and Government)
- Supports pharmacy effort to achieve accreditation by external agencies
- Supports pharmacy related medical management operations to achieve corporate goals for pharmacy
- Serves on internal committees and/or workgroups and completes special projects as assigned
- Participates in local, state, and/or national professional practice organizations
- Doctor of Pharmacy (PharmD) degree required
- 5 years’ clinical experience required, and/or completion of 1 year residency and/or board certification.
- Licensed in Tennessee to practice pharmacy, or eligible for licensure in the state of Tennessee to practice pharmacy
- Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
- Excellent oral and written communication skills
- Strong interpersonal and organizational skills
- Must be a team player, be organized and have the ability to handle multiple projects
- Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability
- Statistics and research design acumen.
- Solid understanding of regulatory guidelines (FDA, NCQA, EQRO) required.
- Competency in compendia navigation and research
Job Specific Requirements:
Experience in managed care pharmacy highly preferred
Number of Openings Available:
BCBST BlueCross BlueShield of Tennessee, Inc.
BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or membership in a historically under-represented group.
BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.
Tobacco-Free Hiring Statement
To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test. An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotineand/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.
Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.
As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health for over 65 years. More than that, we're your neighbors and friends – fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow.