Clinical Pharmacist

The Clinical Pharmacist is responsible for promoting appropriate and/or efficient utilization review of prescription drug claims among BCBSM participating physicians.  This position is also responsible for the education of physicians and influencing of prescribing patterns to reduce BCBSM’s drug benefit payout and improve the quality of the benefits as it relates to our members.  The incumbent serves as the liaison to the Medical Policy department assisting with the development of medical policy as it applies to drugs.

• Provides clinical coverage review for medication requests.
• Develops, implements, and updates Drug Utilization Review/Due Programs.
  Provides effective and efficient communication of pharmacotherapy issues.
• Develops and implements a variety of behavior modification principles to influence physicians to prescribe appropriately.
• Identifies target physicians, establishes credibility and utilizes both verbal and written communications to modify behavior.
• Serves as the key clinical support person for researching prescription drug inquiries.
• Develops, implements and monitors the Corporate Drug Information Center.
• Develops, implements and continually updates physician and patient educational materials.
• Supports Drug Formulary development and serves on the BCBSM P and T Committee.
• Serves as liaison to medical Policy assisting with the development of medical policy as it applies to drugs.
• Participate in clinical and operational process improvement and cost savings opportunities. Support review and resolution of clinical and compliance grievances and appeals.
• Support clinical initiatives related to NCQA, HEDIS, CAHPS and STAR measures. Adhere to Pharmacy Policies and Procedures.

EDUCATION

• Relevant combination of education and experience may be considered in lieu of degree.
• Bachelor’s degree or Doctorate in Pharmacy. 
• Current unrestricted Pharmacy License required, MI Pharmacy License preferred.

EXPERIENCE

• Three years of experience consulting with physicians on pharmaceutical issues or completion of an accredited American Society of Health-System Pharmacists/Academy of Managed Care Pharmacy, AMCP/ASHP, Managed Care Pharmacy or Pharmacy Practice Residency.  Drug Information Specialist with proven background and skills may also be considered.

QUALIFICATIONS

• Must have superior oral and written communication skills and expertise in the design of presentations.  The incumbent must have the ability to obtain and devise relevant data and information from existing MIS Systems.
• An understanding or knowledge of drug claims processing systems and/or medical information systems is preferred.
• Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
• Ability to write reports, business correspondence, and procedure manuals.
• Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

PAY RANGE: Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $107,000 and $179,300.

EEO Statement: All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.

Candidates are hired on an "at will" basis. Nothing herein is intended to create a contract.