Resp & Qualifications
This position is HYBRID with some travel requirements to the MD/DC offices a few times a month but could be more frequent at times.
PURPOSE:
The Formulary Clinical Pharmacist will perform comprehensive clinical services with a focus on formulary management of the commercial pharmacy benefit. Responsibilities will include but are not limited to: oversight of commercial formulary documents and custom coded drug lists, drug trend management, utilization management program monitoring including coverage criteria development/maintenance, and vendor oversight of delegated programs. This position will work in a matrixed environment across the organization.
ESSENTIAL FUNCTIONS:
- Collaborates with internal teams and our Pharmacy Benefit Manger (PBM) to continuously ensure accuracy and compliance for all CareFirst commercial formulary documents, formulary change notifications, and custom coded drug lists for the pharmacy benefit. Utilizes strong organizational skills and an attention to detail to complete work and engage in continuous process improvement. Acts as a formulary and clinical pharmacy expert; providing expertise to both internal and external stakeholders regarding specific formulary considerations, pharmacy trends and market insights.
- Manages custom utilization management program criteria development and maintenance, ensuring clinical appropriateness and proper review/approval by internal and external stakeholders.
- Supports development and execution of strategies to manage pharmacy and medical benefit drug spend for the commercial line of business. Tracks productivity, quality, impact, and overall performance of drug management strategies, clinical pharmacy programs, formularies, and/or utilization management. Identifies areas where program modifications could result in improvements to patient outcomes and reduce costs. Works collaboratively with vendors, PBMs, and internal parties for oversight of programs and performance management.
- Develops and provides formal written and verbal presentations or other communication materials related to formulary management, clinical pharmacy programs, pharmacy utilization, pharmacy strategy, and clinical pharmacy topics to a broad audience including both internal and external stakeholders.
- Reviews pharmacy market information and trends to develop and coordinate the implementation of appropriate strategies or programs for cost containment and clinical management.
QUALIFICATIONS:
Education Level: Ph.DM Pharmacy (Doctorate of Pharmacy)
Experience: 5 years' experience in clinical pharmacy, preferably in a managed care environment.
Licenses/Certifications
PHARMD - Licensed Pharmacist Active in any state and/or DC Registered Pharmacist Upon Hire Required
Preferred Qualifications:
- Thorough understanding of pharmacy benefit management programs and practices or managed care experience preferred. Formal post-graduate residency training preferred.
Knowledge, Skills and Abilities (KSAs)
- Ability to work independently, as well as a member of a team.
- Strong critical reasoning skills in clinical decision-making, planning and organizing.
- Current knowledge of clinical practices and related information systems and computer applications, required.
- A strong balance between clinical expertise and business acumen.
- Strong interpersonal, written and verbal communication skills, including presentation skills.
- Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Salary Range: $115,280 - $206,063 (salaries are based on education, internal equity & years of experience)Salary Range Disclaimer
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
Department
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship.
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