• Job Description

  Req#: R0013168

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  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

  • Coaching Others • Conflict Resolution • Continued Learning • Critical Thinking • Delegating Tasks • Employee Engagement Strategies • Evaluating Information • Interpersonal Communication • Interpersonal Relationships • Management Techniques • Monitor Processes, Materials, or Surroundings • Oral Communications • Problem Sensitivity • Researching • Service Oriented • Time Management • Written Communication

  Responsibilities

  • 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.

  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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