About the Job
The pharmacist position is a part of a multidisciplinary case management team that will focus on complex members who have been identified to be at risk for utilizing significant healthcare resources. The pharmacist must possess strong clinical skills and be interested in working in an integrated team model. In-home visits are part of the program. The pharmacist will conduct a thorough and objective evaluation of the member's medication history to develop a comprehensive pharmaceutical care plan that will address gaps in care. The position is based in the BCBSM Ren Cen office. Medication assessments may be conducted face-to-face
Responsible for promoting appropriate and/or efficient utilization review of prescription drug claims among BCBSM participating physicians. This position is also responsible for the education of physicians and influencing of prescribing patterns to reduce BCBSM’s drug benefit payout and improve the quality of the benefits as it relates to our members. The incumbent serves as the liaison to the Medical Policy department assisting with the development of medical policy as it applies to drugs.
- Participate in clinical coverage review of medication requests, including detection of medication fraud, waste and abuse.
- Develop, implement and update Drug Utilization Review/Evaluation Programs.
- Provide effective and efficient communication of pharmacotherapy issues.
- Develop and implement a variety of behavior modification principles to influence physicians to prescribe appropriately.
- Identify target physicians, establish credibility and utilize both verbal and written communications to modify behavior.
- Serve as the key clinical support person for researching prescription drug inquiries.
- Develop, implement and continually update physician and patient educational materials.
- Support Drug Formulary development, management and publishing of written and web-based Drug Lists and other pharmacy materials and support the BCBSM/BCN P and T Committee.
- Serve as liaison to medical Policy assisting with the development of medical policy as it applies to drugs.
- Participate in clinical and operational process improvement and cost savings opportunities. Support review and resolution of clinical and compliance grievances and appeals.
- Support clinical initiatives related to NCQA, HEDIS, QRS, CAHPS and STAR measures. Adhere to Pharmacy Policies and Procedures.
- Bachelor's Degree or Doctorate in Pharmacy required.
- The Clinical Pharmacist must have at least three (3) years of experience consulting with physicians on pharmaceutical issues or completion of an accredited American Society of Health-System Pharmacists (ASHP) or Academy of Managed Care Pharmacy (AMCP) or Managed Care Pharmacy or Pharmacy Practice Residency.
- Current unrestricted Michigan pharmacy license.
- Experience as a Clinical Pharmacist is required for the Clinical Pharmacist job classification.
- Drug Information Specialist with proven background and skills will also be considered.
- Must have superior oral and written communication skills and expertise in the design of presentations. The incumbent must have the ability to obtain and devise relevant data and information from existing MIS Systems.
- An understanding or knowledge of drug claims processing systems and/or medical information systems is preferred.
- Other related skills and/or abilities may be required to perform this job.
- Minimum of three (3) years pharmacist experience as aforementioned or completion of a PGY1 residency.
- Daily travel may be required for certain programs; personal means of reliable transportation required.
- Valid current Michigan drivers license required; proof of auto liability coverage is required.
All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability