BCBSNE
Clinical Pharmacist
Work at Home - Nebraska
Sponsorship not specifiedDetected 1 day ago
Pharmacy PracticeResearchCommunicationPublic Speaking
About the role
- Our team is the power behind that promise.
- This position will be the expert of the team on clinical issues in conjunction with the Director of Pharmacy and other staff pharmacists.
- This position will be responsible for working in a collaborative culture focused on designing, implementing, maintaining and measuring pharmacy-related utilization management programs.
Responsibilities
- Create and Maintain Clinical Criteria for applicable Utilization Management (UM) programs: Develop and maintain clinical criteria (access to Prime standard and BCBSNE specific versions)
- Develop and maintain criteria process flows
- Develop and maintain physician fax forms and other modes of communication
- Performs highly complex research, analysis and develops recommendations for UM programs & plan design changes.
- Perform clinical support for Pharmacy Technician and other staff
- Develop Decision Tree review process when applicable.
- Maintain URAC accreditation: Work with internal staff to ensure that URAC accreditation is maintained
- Maintain URAC accreditation: Work with internal staff to ensure that URAC accreditation is maintained; The pharmacist will work within their scope of licensure and unless expressly allowed by state or federal law or regulation, are located in a state or territory of the United States when conducting drug utilization review.
- Support Medicare Advantage processes, outreach, presentations, and tasks that require clinical direction and support.
- And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there's no greater time for forward-thinking professionals like you to join us in delivering on it!
Requirements
- Doctor of Pharmacy required from Accredited US College of Pharmacy.
- Support physician reviewers with information required to efficiently review non-approvable claims
- Experience with PBM operations, Medicare Advantage, and/or clinical program development and maintenance.
- Managed Care Pharmacy Residency or 3-4 years of experience in Managed Care Pharmacy industry.
- To be considered for this position, you must have:
Benefits
- At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.
- Utilize reporting tools to create efficiencies by reviewing medical and pharmacy claims data
Company info
- This includes, but not limited to, clinical presentations to internal and external stakeholders, providers, provider offices, and other customers.
- We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.
This listing is sourced directly from BCBSNE's careers page and normalized into a canonical job model.