Job Responsibilities
- Lead, direct, and oversee all clinical aspects of current and future pharmacy benefit programs, ensuring appropriate policies, procedures and resources are in place and aligned with all applicable regulations and requirements
- Directs and manages staff responsible for the development and implementation of new and revised clinical pharmacy services across pharmacy and medical management; ensures strategic alignment of clinical services across the enterprise where appropriate
- Directs and oversees all aspects of staff and any vendor(s) performing case review for the pharmacy care management programs, member appeals, grievances and complaints all within the established time periods
- Leads the management of appropriate drug utilization through formulary creation, clinical criteria development, and utilization management activities, including prior authorization and appeals
Job Qualifications
Education
- Doctor of Pharmacy (PharmD) Degree
Experience
- 7 years - Senior leadership-level experience and documented record of success in management of multi-disciplinary pharmacy operations required
Skills\Certifications
- Competency in compendia navigation and research
- Outstanding negotiation, presentation, and facilitation skills
- Excellent oral and written communication skills
- Adaptive to high pace and changing environment
- Proven effective supervisory and leadership traits to manage and direct others
- Knowledge of medical and pharmacy products
- Basic understanding of provider reimbursement methodologies, including fee schedule pricing, DRG reimbursement, bundled outpatient hospital payment mechanisms, capitation, risk sharing arrangements and other payment methodologies
- Demonstrated consumer healthcare market understanding/knowledge required
License
- Licensed in Tennessee to practice Pharmacy, or eligible for licensure in the state of Tennessee to practice Pharmacy
Number of Openings Available
1
Worker Type:
Employee
Company:
BCBST BlueCross BlueShield of Tennessee, Inc.
Applying for this job indicates your acknowledgement and understanding of the following statements:
BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.
Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:
BCBST's EEO Policies/Notices
BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.
