Clinical Pharmacist - Commercial Markets

The Clinical Pharmacist, in collaboration with other divisions and departments, provides clinical support and leadership for the management and reimbursement of pharmaceutical products, benefit designs, provider networks, mail and specialty distribution. In this position, the Clinical Pharmacist will have the opportunity to optimize pharmacy benefits, enhance utilization management strategies, and develop formulary strategy. This position also fosters relationships with internal departments, professional providers, pharmacies, and employer groups that we serve. This position will also work closely with the pharmacy benefit management (PBM) vendor. This position may also directly work with, or support other lines of pharmacy business.

“This position is eligible to work onsite or hybrid (9 or more days a month on site) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.”

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

Why Join Us

• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.

• Family Comes First: Total rewards package that promotes the idea of family first for all employees.

• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.

• Trust: Work for one of the most trusted companies in Kansas

• Stability: 80 years of commitment, compassion and community

• Flexibility: options to work onsite or hybrid available

• Balance: paid vacation and sick leave with paid maternity and paternity available immediately upon hire

• Inclusive Work Environment: We pride ourselves on fostering a diverse and inclusive workplace where everyone is valued and respected.

Compensation

$112,800  - $134,000 annually
Exempt 18

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid.  All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.
   

What you’ll do

• Provide pharmacy practice, drug product, and drug therapy expertise to the company for utilization review, medical review, customer service and claims processing activities.

• Participate in formulary, benefit design, network, and medical policy recommendations

• Develop and enhance a professional working relationship with providers, pharmacies, professional organizations and other parties involved in the management of the Plan’s Pharmacy Benefits

• Participate and engage in internal and external meetings or committees as a representative of the pharmacy team and Medical Affairs Division

• Assess Plan Pharmacy Benefit practices to determine compliance with federal regulations and laws

• Collaborate with internal and external stakeholders to enhance member access to appropriate and affordable therapies, including communication of changes to groups, providers, and members.

• Assist and support quality management programs that promote measurement, monitoring, and evaluation of services and work processes to improve the quality-based activities and outcomes

• Provide vendor oversight and monitoring of clinical programs put into place alongside the Pharmacy Benefit Manager

• Serve as a resource for resolving pharmacy claims, customer service escalations, and provider inquiries related to coverage and utilization.

What you need

Knowledge/Skills/Abilities

• Requires strong knowledge of clinical pharmacy, chronic disease management, biologic and biopharmaceutical products, drug information systems, and drug delivery system.

• Requires knowledge of pharmacy practice, including trends and reimbursement, at the national and local level.

• Requires strong knowledge of State and Federal pharmacy laws and regulations

• Requires working knowledge in the evaluation of clinical drug trials, outcomes research and Pharmacoeconomics.

• Requires an understanding of formulary and utilization management

• Demonstrates interpersonal skills, and is able to easily collaborate wit