Clinical Pharmacist - Specialty Drug Utilization Management (Hybrid)

RESP & QUALIFICATIONS

PURPOSE The Clinical Pharmacist will perform comprehensive clinical services with a focus on utilization management for specialty drugs covered under the pharmacy and medical benefit. Responsibilities will include but are not limited to:

• Utilization management program development
• Monitoring coverage criteria development
• Clinical drug evaluations
• Development of drug management tools
• Vendor oversight for delegated programs

This position will work in a matrixed environment across the organization.

ESSENTIAL FUNCTIONS

• Develops and executes on strategies to manage pharmacy and medical benefit drug spend with a focus on specialty drugs.
• Tracks productivity, quality, impact, and overall performance of utilization management strategies.
• Identifies areas where program modifications could result in improvements to patient outcomes and reduce costs.
• Works collaboratively with vendors, PBMs, and internal parties for oversight of programs and performance management.
• Acts as a specialty drug subject matter expert, providing expertise to both internal and external stakeholders regarding specific pharmacy trends and market insights; provides recommendations to control specialty drug costs across pharmacy and medical benefits.
• Develops and provides formal written and verbal presentations or other communication materials related to specialty drug management, pharmacy utilization, pharmacy strategy, and pharmacy topics to a broad audience including both internal and external stakeholders.
• Assesses value of specialty drug management strategies through clinical outcomes, usage, quality, and financial metrics to assist in meeting strategic plan goals.
• Ensures pharmacy programs are compliant with regulatory mandates.
• Reviews pharmacy market information and trends to develop and coordinate implementation of appropriate strategies or programs for cost containment and clinical management with a focus on specialty drugs.

QUALIFICATIONS

Education

• Level: Ph.D. Pharmacy / Doctorate of Pharmacy.

Licenses & Certifications (Upon Hire Required)

• PHARM.D - Licensed Pharmacist (Direct Patient Care): Active Registered Pharmacist in Maryland and/or DC.
• PHARM.D - Licensed Pharmacist (No Direct Patient Care): Active Registered Pharmacist in any state and/or DC.

Experience

• 5 years experience in clinical pharmacy, preferably in a managed care environment.

Preferred Qualifications

• Experience in Medicare and/or Medicaid.
• Experience working in healthcare industry with a thorough understanding of prescription benefit management programs and practices across multiple lines of business (Commercial, Medicare, Medicaid) with a focus on specialty pharmacy.
• Certified Specialty Pharmacist (CSP) credential preferred.

Knowledge, Skills, and Abilities (KSAs)

• Ability to work independently as well as a member of a team.
• Strong critical reasoning skills in clinical decision-making, planning, and organizing.
• Current knowledge of clinical practices and related information systems and computer applications required.
• A strong balance between clinical expertise and business acumen.
• Strong interpersonal, written, and verbal communication skills, including presentation skills.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers within set expectations for service excellence.
• Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Salary Range $120,160 - $214,786

Salary Range Disclaimer The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as, but not limited to, the scope and responsibilities of the position, the candidates work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range as compensation decisions depend on each cases facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs, plans, and 401k contribution programs. All benefits/incentives are subject to eligibility requirements.

Department Government Programs / Specialty

Equal Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply Please visit our website to apply: www.carefirst.com/careers

Federal Disclosure Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key, and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US Must be eligible to work in the U.S. without Sponsorship.

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