Job Description
We are seeking a proactive and knowledgeable Sr. Clinical Pharmacist to join our team. In this role, you will conduct targeted provider outreach to optimize Medicare drug therapies and identify cost-savings opportunities for both the plan and members. Utilize integrated data analytics to prioritize outreach opportunities, document interventions on a web-based platform, and calculate plan savings for reporting. Collaborate via telephonic and fax communication with providers, pharmacies, and members to achieve enhanced health outcomes and reduce overall drug expenditure. Engage in continuous monitoring and follow-up to assess the financial impact of successful interventions. Partner with additional clinical pharmacists to provide insights and feedback to improve processes and enhance overall efficiency.What You'll Do
Performs high-touch provider outreach to recommend optimization of drug therapies and cost-saving measures for the Medicare line of business.
Utilizes an integrated data analytics application that identifies non-optimized drug use and cost-saving opportunities.
Leverage current clinical guidelines and evidence-based research to support recommended interventions, adhering to any Trade, Legal, or Compliance considerations.
Evaluates rule logic categories to prioritize workload and make timely interventions.
Conducts phone outreach with providers, pharmacies, and members to communicate recommendations and ensure end-to-end execution of the opportunities.
Documents all interventions in a web-based platform for tracking and reporting.
Calculates Medicare plan savings upon successful intervention for validation, tracking, and reporting.
Presents progress and savings quarterly to Corporate Pharmacy and other leadership teams.
Ensures clinical compliance with law and regulatory bodies, including the Centers for Medicare and Medicare Services (CMS).
Collaborates with PBM and internal Medicare teams to identify new clinical pharmacy strategies which result in high-quality, cost-effective pharmacy management and outcomes.
Manages and supports academic detailing programs.
Pursues active membership in professional organizations and seeks continual professional development to identify industry trends, best practices, and innovative solutions to current and emerging industry challenges.
What You'll Bring (Hiring Requirements)
Bachelor's degree or advanced degree
5+ years of experience in related field
In lieu of degree, 7+ years of experience in related field
Licensed pharmacist or eligible for licensure in North Carolina
Ideal candidates must possess excellent oral and written inter-personal communication skills, time management, and critical thinking skills
Candidates with Medicare managed care experience and academic detailing experience will be preferred.
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.
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