Clinical Pharmacist

Job Description

***Note: The designated shift for this position will be 10 AM - 7 PM EST (Monday - Friday)***

What You Will Do

• Review prior authorization requests and make determinations for drug products according to member benefits and coverage criteria

• Report utilization review statistics to corporate compliance committees

• Review data and summarize daily utilization review numbers

• Responsible for tracking compliance of review cases

• Provide clinical guidance and support to the assigned pharmacy technicians

• Knowledge of drug coding (NDC, GCN, GPI and USC) and NCPDP claims adjudication systems

• Review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design.

• Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practices

• Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews

What You Bring

• Bachelor's degree or advanced degree

• 3+ years of experience in related field

• Licensed NC pharmacist or eligible for licensure in North Carolina.

Bonus Points (preferred qualifications)

• Background in ambulatory care and/or retail pharmacy environments.

• Strong ability to engage with patients and health plan members in a professional and empathetic manner.

• Excellent communication skills tailored to customer, patient, and member needs.

• Familiarity with a wide range of disease states and chronic conditions.

• Working knowledge of Medicare programs and processes.

• Experience serving the geriatric population, with sensitivity to their unique healthcare needs.

What You'll Get

• The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community

• Work-life balance, flexibility, and the autonomy to do great work

• Medical, dental, and vision coverage along with numerous health and wellness programs

• Parental leave and support plus adoption and surrogacy assistance

• Career development programs and tuition reimbursement for continued education

• 401k match including an annual company contribution

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

Skills