• Job Description

  Req#: R1028658

  
  Summary
  

  Responsible for clinical management of pharmacy services available to BCBSSC commercial members and current and/or prospective employer group clients. Role includes consultative services for groups as well as oversight of day-to-day operational activities.

  
  Description
  

  Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

  Position Purpose:

  The Pharmacy Director is responsible for the clinical management of pharmacy services available to BCBSSC commercial members and current and/or prospective employer group clients. The role includes consultative services for groups and oversight of day-to-day operational activities. This leader must have a strategic mindset to build the vision and plan and the operational skill set to implement the strategy while driving the efficiency and scalability of the operations.

  Logistics:

  This is a full-time position working (40-hours/week) Monday-Friday 8:00am – 5:00pm Central Standard Time working in a remote capacity within the United States with some travel required.

  What You’ll Do:

  • Acts as SME/consultant between BCBSSC commercial lines of business and key clients to support pharmacy benefit management (PBM) clinical operations. Builds and fosters relationships with client contacts through quality service delivery.

  • Develops strategies to best manage pharmacy costs for clients and their membership.

  • Communicates clinical operational program initiatives, changes and quality improvement related items to customers, with a key focus on formulary management and recommendations. Leads and participates in ad hoc meetings with targeted high profile, high touch customers. Ensures client satisfaction with formulary and clinical programs throughout plan implementation and plan administration.

  • Reviews and oversees coverage determination and appeal, requests including but not limited to, prior authorization, step therapy, quantity limit, tier exceptions, and non-formulary exception requests.

  • Provides and presents drug information/drug evaluation reviews and suggestions to clients and their appropriate HR and/or clinical committee(s).

  • Manages all client level formulary and clinical program inquiries from receipt through to resolution.

  • Assists in performing drug reviews and supporting utilization management and case management teams.

  • Performs other duties as assigned.

  To Qualify for This Position, You’ll Need:

  • Doctorate in Pharmacy, OR Bachelor's degree in Pharmacy.

  • 8 years pharmacy experience;

  • 3 years managed care experience or 3 years in a leadership/administrative position in a large group or hospital setting (may be concurrent with the 8 years).

  • Working knowledge of clinical and formulary issues and the ability to independently identify, research and resolve issues.

  • Pharmaceutical and medical knowledge necessary to effectively discuss drug therapy issues with other clinicians.

  • Comprehensive knowledge of pharmacy industry to include pharmacy benefit, management and/or pharmaceutical sales.

  • Knowledge of healthcare industry. Excellent communication (verbal and written), interpersonal, and organizational skills.

  • Ability to work with peers in a team effort. Ability to exercise good judgment with capacity of communicating with a diverse range of individuals.

  • Demonstrated ability to manage multiple priorities and deadlines Ability to handle confidential or sensitive information with discretion.

  • Ability to persuade, negotiate, or influence others.

  • Microsoft Office.

  Preferred Work Experience:

  • Effective communication skills both written and verbal

  • Excellent time management skills

  • Managed care/health plan experience

  Required Licenses and Certificates:

  • Active, unrestricted Pharmacy licensure from the United States and in the state of hire.

  What We Can Do for You:

  We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have access and opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

  Our comprehensive benefits package includes:

  • 401(k) retirement savings plan with company match

  • Health Insurance

  • Free vision coverage

  • Voluntary dental, vision, and life insurance

  • Paid annual leave — the longer you work here, the more you earn

  • Nine paid holidays

  • On-site cafeterias and fitness centers in major locations

  • Wellness programs and a healthy lifestyle premium discount

  • Tuition assistance

  • Service recognition

  What to Expect Next:

  After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with those candidates who qualify with prioritization given to those candidates who demonstrate the preferred qualifications.

  
  
  

  We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

  Equal Employment Opportunity Statement

  BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

  We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

  If you need special assistance or an accommodation while seeking employment, please e-mail abilities@bcbssc.com or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

• About the company

  When you hear "BlueCross BlueShield of South Carolina," you'll see people nodding in recognition. Most everyone knows who we are. As the only South Carolina-owned and operated health insurance carrier, we have been offering security to Palmetto State citizens for more than 70 years. We are also one of South Carolina's largest employers.

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