BlueCross BlueShield of Tennessee Director, Clinical Pharmacy in Chattanooga, Tennessee

The Director of Clinical Pharmacy is responsible for all aspects of maintaining the clinical integrity of the pharmacy care management programs, pharmacy utilization management processes, and the specialty drug management on both the pharmacy and medical benefits. He/she is responsible for guiding the strategic direction of all clinical initiatives across the enterprise and all LOBs including drug formulary and coverage management. The Director of Clinical Pharmacy will use clinical and analytic skills to examine utilization patterns and trends to aid in the development of innovative management programs. The Director of Clinical Pharmacy will be responsible for guiding his/her staff of pharmacists, nurses and technical staff to develop and deliver superior pharmacy programs to BCBST members.

Job Description:

Job Duties & Responsibilities

  • Lead, direct, and oversee all clinical aspects of current and future pharmacy benefit programs, ensuring BCBST has appropriate policies, procedures and resources aligned with all applicable regulations and requirements
  • Directs and manages staff responsible for the development and implementation of new and revised clinical pharmacy services across pharmacy and medical management; ensures strategic alignment of clinical services across the enterprise where appropriate
  • Leads the development and implementation of specialty initiatives across pharmacy and medical management, such as a holistic cancer care program and a rare chronic disease specialty management program
  • Directs and oversees all aspects of staff and any vendor(s) performing case review for the pharmacy care management programs, member appeals, grievances and complaints all within the established time periods
  • Leads the management of appropriate drug utilization through medical policy and appeals
  • Provides strategic guidance and support where appropriate of quality programs mandated by contractual requirements including but not limited to HEDIS, STARs, Evaluat8, MTM, Opioid DUR programs, polypharmacy, controlled substance monitoring, high risk medication monitoring and DSNP yearly member medication review.

  • Coordinates closely with the Director of Pharmacy Market Development in order to offer the most cost effective and competitive clinical services across markets

  • Oversees the direction and management of staff responsible for P&T activities for all formularies; ensures strategic alignment of formulary management across the enterprise where appropriate

  • Leads the Corporate P&T committee and serves as the pharmacy department’s representative on the following committees: MTAS, Appeals and Grievances, Credentialing, and others as appropriate

  • Oversees the drug prior authorization, appeals, medical policy and provider grievance
  • Direct supervisory responsibility of clinical pharmacists and technical staff

Job Qualifications

Education

  • Licensed in Tennessee to practice pharmacy, or eligible for licensure in the state of Tennessee to practice pharmacy
  • Doctor of Pharmacy (PharmD) degree required; completion of a specialized residency program (e.g. Managed Care, drug information, pharmacotherapy, etc.) preferred
  • Additional advanced degree (MBA, MS, MPH, PhD) preferred

Experience

  • Minimum of 7 years clinical experience (managed care) required, with a focus in specialty drug management and knowledge of pharmacy prior authorization and appeals processes

Skills/Certifications

  • Knowledge of the pharmaceutical industry and its products
  • Excellent communication and presentation skills, both verbal and written are essential.
  • Competency in compendia navigation and research
  • Ability to adapt to an ever changing business environment and priorities
  • Understanding of provider reimbursement methodologies
  • Understanding of trends and issues related to health care insurance industry
  • Ability to communicate with a diverse range of individuals
  • Ability to persuade, negotiate or influence others
  • Proven ability provide guidance to direct and matrixed staff

Job Specific Requirements:

Number of Openings Available:

1

Worker Type:

Employee

Worker Sub-Type:

Regular

Company:

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.

About Us

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.