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Senior Pharmacist, Medication Policy Job
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| Employer Name: |
SpiderID: 13140231 |
| Location: Rancho Cordova, California |
Date Posted: 12/23/2022 |
| Wage: Negotiable |
Category: Insurance |
| Job Code: 17002FZ-2191 |
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Job Description:
 Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California's Mission is to ensure all Californians have access to high-quality care at an affordable price. Blue Shield is focused on improving health care delivery by working closely with providers and making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 4 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than $325 million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution.
We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.
Description:
This position is primarily responsible for supporting the Blue Shield of California Pharmacy and Therapeutics (P&T) Committee process, and supports the operational components of the Medical Benefit Drug Authorization Program by ensuring that evidence based clinical criteria approved by the Blue Shield of California Pharmacy and Therapeutics Committee are implemented operationally in order to provide a quality, cost effective care.
This position is specifically responsible to:
- Supports the operational implementation and maintenance of medication policies for drugs in the medical benefit.
- Supports the configuration of clinical rules in the automated prior authorization system for medical benefit drugs.
- Ensure compliance with various regulatory and quality accreditation requirements around drug utilization management to support safe, efficacious, and cost-effective prescribing.
- Works in conjunction with the MCS Medical Policy team to develop and support office injectable medication policies for implementation in claims payment systems.
- Supports the Claims Operations team by ensuring that payment instructions are current, updated and easy to use
- Participates in daily Clinical Pharmacy rounds to monitor any need to update or implement applications in claims processing
- Provide pharmacotherapy expertise for the pharmacy program by supporting the Pharmacy and Therapeutics Committee, drug formulary, prior authorization, drug utilization review and physician reporting programs.
Qualifications:
Pharm. D. degree in Pharmacy and two years' experience in clinical pharmacy, or equivalent combination of education and experience, plus current California Pharmacy License.
Thorough clinical knowledge regarding therapeutic use of drugs.
Excellent oral and written communication skills.
Proficient with computers and related software applications.
Job Criteria:
Start Date:
Position Type: Full-Time Permanent
Years of Experience Required:
Education Required:
Overnight Travel:
Vacation Time:
Contact Information:
| Contact Name: Blue Shield of California |
Company Type: |
| Company: Blue Shield of California |
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