Clinical Pharmacist

🔥 21 hours ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $118.7k - $189.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

👻 Ghost score 0%

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Blue Cross NC

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Blue Cross NC is a health insurance provider that offers a range of health plans and services to individuals and groups. The company focuses on delivering quality healthcare coverage and improving health outcomes for its members through innovative health programs and services. Blue Cross NC is committed to enhancing access to affordable healthcare while supporting the health and wellness of the communities it serves.

📋 Description

• Provide timely drug therapy for health plan members by reviewing and processing prior authorization requests using clinical judgment and medical policy • 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 • Track compliance of review cases • Provide clinical guidance and support to assigned pharmacy technicians • 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

🎯 Requirements

• Bachelor's degree or advanced degree • 3+ years of experience in related field • Current states pharmacy license • Knowledge of drug coding (NDC, GCN, GPI and USC) • Knowledge of NCPDP claims adjudication systems • Knowledge of guideline criteria for prior authorization and non-formulary drugs • Clinical judgment and medical policy knowledge • Drug knowledge and disease state understanding • Knowledge of pharmacy practices, quality controls, and performance improvement • Knowledge of pharmacy regulation, medication management, medication safety, and related pharmacy operations

🏖️ Benefits

• Annual Incentive Bonus based on annual corporate goal achievement and individual performance • 401(k) with employer match • Paid Time Off (PTO) • Competitive health benefits • Wellness programs • Robust Total Rewards package