Clinical Pharmacist

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Job Summary:

This position is accountable for supporting Pharmacy clinical management. The responsibilities include assisting in formulary management, medication therapy management, utilization management, research and collaboration with disease management and medical management.

Responsibilities:

• Supports the pharmacy formulary management program, medication therapy management program, and related P&T committee activities.

• Supports prior authorization program by handling prior authorization requests from Pharmacies and physicians through existing policies and procedures.

• Interfaces with medical directors, and other areas for Pharmacy related initiatives

• Supports the Utilization management program.

• Responsible for member interface through comprehensive medication review for Medicare beneficiaries.

• Assist in managing and training Pharmacy techs for Medication therapy management.

• Responsible for Medicare beneficiaries pharmacy management program, understand the mandates and follow the guidelines.

• Supports clinical programs both internally and externally.

• Assists with the internal drug information services.

• On call responsibility as required.

• Reviews and analyze reports on utilization management, and evaluates business needs for data analysis.

• Support the Drug Utilization review program.

• Manage and update formulary communications.

• Coordinates projects with activities performed by other clinical Pharmacists for the residents and students.

• Participates in the Pharmacy Case Management Program.

• Supports the pharmacy lock-in program including profile review and presentation.

• Maintains and reports relevant drug pipeline/patent loss detail to medical team.

• Supports the timely review of Pharmacy appeals.

• Assists in the creation of member and provider newsletters.

Disclaimer:
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Education/Experience:

• Requires a bachelor's of science degree in pharmacy from an accredited college or university.

• Prefers a Pharm D from an accredited college or university.

• Prefers up to one to two year experience in managed care.

• Requires retail, or other pharmacy experience.

Additional licensing, certifications, registrations:

• Active Unrestricted NJ Pharmacy License Required

Knowledge:

• Requires working knowledge of pharmaceutical and managed care industries.

• Requires knowledge of a spreadsheet software package.

• Requires knowledge of a database software package.

• Requires knowledge of Clinical therapeutics and basic therapy and guidelines and recommendations.

• Requires knowledge of Internet clinical information databases.

Skills and Abilities:

• Strong negotiation skills with the demonstrated sales ability to convert prospect to client in addition to demonstrated persuasive skills with carriers

• Must have effective verbal and written communication skills and demonstrate the ability to work well within a team. Demonstrated ability to deliver highly technical information to less technical individuals.

• Must demonstrate professional and ethical business practices, adherence to company standards, and a commitment to personal and professional development.

• Proven time management skills are necessary. Must demonstrate the ability to manage multiple priorities [or tasks], deliver timely and accurate work products with a customer service focus, and respond with a sense of urgency as required. Demonstrated ability to work in a production focused environment.

• Proven ability to exercise sound judgment and strong problem solving skills.

• Proven ability to ask probing questions and obtain thorough and relevant information.

• Must be client service focused with effective ability to empathize.

• Needs to demonstrate willingness to cross-train, and be cross-trained, in other roles/duties.

• Must be detail oriented with strong organizational and data processing skills. Proven ability to follow detailed instructions is essential, along with proven problem solving skills.