Job Description
We are seeking a Clinical Pharmacist to join our team! As a Clinical Pharmacist, you will provide timely drug therapy for health plan members by reviewing and processing prior authorization requests using clinical judgment and medical policy.***Note: The designated shift for this position will be 10 AM - 7 PM EST (Monday - Friday)***
What You Will Do
Review prior authorization requests and make determinations for drug products according to member benefits and coverage criteria
Report utilization review statistics to corporate compliance committees
Review data and summarize daily utilization review numbers
Responsible for tracking compliance of review cases
Provide clinical guidance and support to the assigned pharmacy technicians
Knowledge of drug coding (NDC, GCN, GPI and USC) and NCPDP claims adjudication systems
Review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design.
Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practices
Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
What You Bring
Bachelor's degree or advanced degree
3+ years of experience in related field
Licensed NC pharmacist or eligible for licensure in North Carolina.
Bonus Points (preferred qualifications)
Background in ambulatory care and/or retail pharmacy environments.
Strong ability to engage with patients and health plan members in a professional and empathetic manner.
Excellent communication skills tailored to customer, patient, and member needs.
Familiarity with a wide range of disease states and chronic conditions.
Working knowledge of Medicare programs and processes.
Experience serving the geriatric population, with sensitivity to their unique healthcare needs.
What You’ll Get
The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community
Work-life balance, flexibility, and the autonomy to do great work
Medical, dental, and vision coverage along with numerous health and wellness programs
Parental leave and support plus adoption and surrogacy assistance
Career development programs and tuition reimbursement for continued education
401k match including an annual company contribution
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.
Skills