• Job Description

  Req#: R0012463

  To learn more about Arkansas Blue Cross and Blue Shield Hiring Policies, please click here.

  Applicants must be eligible to begin work on the date of hire. Applicants must be currently authorized to work in the United States on a full-time basis. ARKANSAS BLUE CROSS BLUE SHIELD will NOT sponsor applicants for work visas in this position.

  Arkansas Blue Cross is only seeking applicants for remote positions from the following states:

  Arkansas, Florida, Georgia, Illinois, Kansas, Louisiana, Minnesota, Mississippi, Oklahoma, South Carolina, Tennessee, Texas, Virginia and Wisconsin.

  Workforce Scheduling

  Job Summary

  The Clinical Pharmacist - Utilization Management will report to and operate under the direction of Pharmacy leadership and will also be expected to work cooperatively and sometimes independently with all medical directors and others within the Enterprise.

  Requirements

  EDUCATION

  Bachelor's degree in Pharmacy from an accredited college of pharmacy.

  LICENSING/CERTIFICATION

  Holds a current, unrestricted license in pharmacy in the state(s) where job duties are performed required.

  EXPERIENCE

  Minimum three (3) years' pharmacy practice experience.

  Minimum three (3) years' experience in managed pharmacy care and drug utilization review preferred.

  Previous pharmacy technician experience desirable.

  ESSENTIAL SKILLS & ABILITIES

  Oral & Written Communication

  Presentation

  Organizational

  Analytical

  Problem-Solving

  Decision-Making

  Skills

  Responsibilities

  Conducts the second level review for medical and pharmacy benefit medication prior-authorizations, exceptions, and medical necessity reviews submitted to the plan. Reviews and interprets coverage across all lines of business to determine what type of review is required. 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, Contributes to and supports Enterprise-wide undertakings and commitments, Drafts pharmaceutical medical criteria and performs other activities in support of the enterprise prior authorization program, Follows policies and procedures to ensure appropriate alignment of medical policies and configuration for claims processing and utilization management. Contributes to and supports Enterprise-wide undertakings and commitments, Implements pharmacy cost containment strategies, Medical/Clinical: Upholds clinical integrity of pharmaceutical solutions by staying up-to-date on medication information, contributing to the identification of pharmacy program best practices, collaborating with Medical Directors, Leadership, and Clinical Dept and provides pharmacy expertise within the organization, Serves as a liaison to individual pharmacists, professional pharmacy organizations, internal committees, case management, medical management and other providers on pharmacy issues, Serves as subject matter expert for medical pharmacy authorizations and coverage for specific lines of business, Supports overall Medical Pharmacy product line for health plan, 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, Works with the clinical and operations staff of all vendors of pharmacy programs to ensure that members and providers are receiving a satisfactory level of service

  Certifications

  Pharmacist License - Arkansas State Board of Pharmacy

  Security Requirements

  This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.

  Segregation of Duties

  Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.

  Employment Type

  Regular

  ADA Requirements

  1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.

• About the company

  Founded in 1948, Arkansas Blue Cross and Blue Shield, an Independent Licensee of the Blue Cross and Blue Shield Association, is the largest health insurer in Arkansas. Arkansas Blue Cross and its family of affiliated companies have more than 3,200 employees.

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