Pharmacist, Consultant

JOB DESCRIPTION
Your Role

The Federal Employee program (FEP) team supports the Blue Cross Blue Shield Federal Employee Program (FEP) medical benefit medication process and supports the clinical components of the Medical Management Pre-Service Program. The Pharmacist, Consultant (Federal Employee Program) will report to the Senior Manager, Medical Benefit Prior Authorization. In this role you will ensure that evidence-based clinical decisions of the Blue Cross Blue Shield Federal Employee Program Medication Policies are implemented operationally in order to provide a quality, cost effective medical benefit. This position is also responsible for Medication Therapy Management provided to members.

Your Work

In this role, you will:

• Support the operational and clinical implementation of medication policies for injectable drugs covered under the medical benefit for the FEP PPO line of business
• Provide pharmacist support for the FEP Medical Management Pre-service team by providing clinical expertise to the team to ensure accurate review of pre-service medication requests within all regulatory required time frames. Duties also extend to post service clinical medication reviews
• Ensure compliance with various regulatory and quality accreditation requirements around drug utilization management to support safe, efficacious, and cost-effective prescribing
• 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
• Participate in daily pharmacy clinical rounds to monitor any need to update or implement applications in claims processing or medication policy
• Serve as an educational resource to internal and external constituents regarding the Blue Cross Blue Shield FEP drug formulary, medication policies and appropriate drug use
• Perform medication consultations with members/providers, as needed
• Support Healthcare Effectiveness Data and Information Set (HEDIS) compliance for medication related measures

QUALIFICATIONS
Your Knowledge and Experience

• Requires a Doctor of Pharmacy (PharmD) degree
• Requires a currently active and unrestricted California Registered Pharmacist (RPh) license
• Requires at least 2 years of experience in clinical pharmacy
• Thorough clinical knowledge regarding therapeutic use of medications
• Excellent math, analytical, and problem-solving skills
• Proficient with computers and related software applications
• Previous Medication therapy management (MTM) and Healthcare Effectiveness Data and Information Set (HEDIS) experience preferred

Pay Range:

The pay range for this role is: $118,800.00 to $178,200.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

ABOUT THE TEAM
Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California’s top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

Our Values:

• Honest . We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human . We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
• Courageous . We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model:

Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That’s why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.

Two ways of working: Hybrid (our default) and office

• Hybrid – In a business unit approved office a few times per year to 3 days per week, on average

• Office – In a business unit approved office 4+ days a week, on average. If the role you’re applying for is deemed an “Essential Role,” the company has determined that the role can only be performed in a Blue Shield office or in the field and would require your to meet the office worker classification.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.