Clinical Pharmacist

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Arkansas Blue Cross and Blue Shield

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1948

⚕️ Healthcare Insurance

Healthcare Insurance

Arkansas Blue Cross and Blue Shield is a health insurance provider licensed to offer health plans in all 75 counties of Arkansas. The company offers a wide range of insurance products including individual and family plans, Medicare and Medigap plans, dental and vision plans, as well as health plans for travelers and employer group plans. They provide members with personalized services such as health management through the Blueprint Portal, where users can manage their health plan, review claims, find healthcare providers, and estimate treatment costs. Arkansas Blue Cross and Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association.

📋 Description

• Assists in development and supervises the drug utilization and prior authorization review program. • Develops and implements pharmacy cost containment strategies tailored to the specific situations and patterns of the enterprise, specific regions, and large accounts. • Drafts pharmaceutical criteria and performs other activities in support of the enterprise prior authorization program. • Keeps up-to-date on medication information, contributing to the identification of pharmacy program best practices, collaborating with Medical Directors, leadership, and clinical department as a subject matter expert (SME). • May be responsible for conducting the second level review for medical and pharmacy benefit medication prior-authorizations, exceptions, and medical necessity reviews submitted to the plan. • May be responsible for ensuring appropriate alignment of medical policies and configuration for claims processing and utilization management. • Performs other duties as assigned. • Prepares and presents reports, data and analyses on the utilization and cost trends for enterprise lines of business, specific regions, and large accounts. • Provides leadership and advice on developing and implementing pharmacy reimbursement, claims processing policies and procedures, and pharmacy vendor selection. • Reviews and interprets coverage across assigned line(s) of business to determine what type of review is required and works with requesting providers, corporate medical directors, and other internal staff, as appropriate, in determining whether a specific case presentation meets the criteria for approval according to the specific coverage criteria. • Serves as a liaison to individual pharmacists, professional pharmacy organizations, internal committees, case management, medical management, and other providers on pharmacy issues. • Supports pharmacy initiatives for member, provider, and client satisfaction. • Uses clinical knowledge and independent critical thinking skills towards interpreting criteria, policies, and procedures to make determinations on prior approval reviews and retrospective reviews and/or pharmacy consultations within case management. • Uses knowledge of the pharmacy and/or medical benefit to communicate with, and provide recommendations to Care Management nurses, social workers, and medical directors. • Uses knowledge of the pharmacy and/or medical benefit to ensure our members receive their medications in a timely fashion, avoiding delays in treatment.

🎯 Requirements

• Bachelor's degree in Pharmacy from an accredited college of pharmacy. • Holds an active and current, unrestricted license in pharmacy in the state(s) where job duties are performed required. • Minimum three (3) years' pharmacy practice experience. • Minimum three (3) years' experience in managed pharmacy care and drug utilization review preferred.

🏖️ Benefits

• Tuition reimbursement. • Club Blue, a free, onsite gym to encourage exercise. • Green Leaf Grill and Green Leaf Grill Express, onsite restaurants in Little Rock that promote healthy eating. • Incentives for wellness education and exercise.