Pharmacist, Consultant

2 weeks ago

United States CA Rancho Cordova Blue Shield of California Full time

Your Role

The Pharmacy Services Drug Utilization Management team provides efficient and accurate responses to external customer (physicians, office staff, pharmacy providers, members and brokers) and internal team members for all outpatient medical benefit inquires. The Pharmacist Consultant will report to the Manager of Medical Benefit Drug Utilization. In this role you will support the Blue Shield of California Pharmacy and Therapeutics (P&T) Committee process and support the clinical components of the Pharmacy Services Drug Utilization Program by ensuring that evidence based clinical decisions of the Blue Shield of California Pharmacy and Therapeutics Committee are implemented operationally in order to support safe, efficacious, and cost-effective prescribing of medications provided under the medical benefit.

 

Your Work

In this role, you will:

  • Provide pharmacotherapy expertise for Blue Shield’s pharmacy program by supporting: Pharmacy and Therapeutics Committee, drug formulary, drug prior authorization and utilization review programs, health plan benefit design, member/provider communications related to medication use, and the pharmacy student/residency programs
  • Operate in compliance with all regulatory and accreditation requirements, and corporate policies and procedures regarding to support access to safe, efficacious, and medically necessary medications 
  • Assist in preparing materials for audits and reports; completes projects as assigned
  • Support the operational and clinical implementation of medication policies for drugs provided under the medical benefit, for both Commercial, Medicare, and Medi-Cal lines of business
  • Support the peer to peer process and facilitate provider discussion regarding prior authorization denials.
  • Provide pharmacist support for the drug prior authorization program by providing clinical expertise to Prior Authorization technician team to ensure review of prior authorization requests within regulatory required time frames
  • Provide clinical and operational expertise in post service requests, completed within regulatory required time frames
  • Ensure compliance with various regulatory and quality accreditation requirements around drug utilization management in order to support safe, efficacious, and cost-effective prescribing
  • Serve as an educational resource to internal and external constituents regarding the Blue Shield drug formulary, medication policies and appropriate drug use 

Your Knowledge and Experience

  • Requires a Doctor of Pharmacy (PharmD) degree
  • Requires a currently active and unrestricted California Registered Pharmacist (RPh) license
  • Requires at least 2 years of experience in clinical pharmacy
  • Prior experience in managed care/PBM is preferred
  • Thorough knowledge of therapeutic use of medications is preferred
  • Excellent oral and written communication skills is preferred

 

*Must be available to work at least one weekend per month and company holidays as needed to ensure regulatory compliance with prior authorization turnaround times.

Pay Range: 

The pay range for this role is: $ 118800.00 to $ 178200.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

#LI-SS8

  • Pharmacist, Consultant

    2 weeks ago

    Rancho Cordova, CA, United States Blue Shield of California Full time

    Your Role The Pharmacy Services Drug Utilization Management team provides efficient and accurate responses to external customer (physicians, office staff, pharmacy providers, members and brokers) and internal team members for all outpatient medical benefit inquires. The Pharmacist Consultant will report to the Manager of Medical Benefit Drug Utilization....

  • Pharmacist, Consultant

    2 weeks ago

    Rancho Cordova, United States Blue Shield of California Full time

    Your Role The Pharmacy Services Drug Utilization Management team provides efficient and accurate responses to external customer (physicians, office staff, pharmacy providers, members and brokers) and internal team members for all outpatient medical benefit inquires. The Pharmacist Consultant will report to the Manager of Medical Benefit Drug Utilization. In...

  • Pharmacist, Consultant

    3 weeks ago

    Rancho Cordova, United States Blue Shield Of California Full time

    Your Role The Pharmacy Services Drug Utilization Management team provides efficient and accurate responses to external customer (physicians, office staff, pharmacy providers, members and brokers) and internal team members for all outpatient medical benefit inquires. The Pharmacist Consultant will report to the Manager of Medical Benefit Drug Utilization. In...

  • Pharmacist, Consultant

    3 weeks ago

    Rancho Cordova, United States Blue Shield of California Full time

    Your Role The Pharmacy Services Drug Utilization Management team provides efficient and accurate responses to external customer (physicians, office staff, pharmacy providers, members and brokers) and internal team members for all outpatient medical benefit inquires. The Pharmacist Consultant will report to the Manager of Medical Benefit Drug Utilization. In...

  • Pharmacist, Consultant

    2 weeks ago

    Rancho Cordova, United States Blue Shield Of California Full time

    Your Role The Pharmacy Services Drug Utilization Management team provides efficient and accurate responses to external customer (physicians, office staff, pharmacy providers, members and brokers) and internal team members for all outpatient medical benefit inquires. The Pharmacist Consultant will report to the Manager of Medical Benefit Drug Utilization. In...

  • Pharmacist, Consultant

    2 weeks ago

    Rancho Cordova, United States Blue Shield of California Full time

    Your Role The Pharmacy Services Drug Utilization Management team provides efficient and accurate responses to external customer (physicians, office staff, pharmacy providers, members and brokers) and internal team members for all outpatient medical benefit inquires. The Pharmacist Consultant will report to the Manager of Medical Benefit Drug Utilization. In...

  • Pharmacist, Consultant

    2 weeks ago

    Rancho Cordova, United States Blue Shield of California Full time

    Your Role The Pharmacy Services Drug Utilization Management team provides efficient and accurate responses to external customer (physicians, office staff, pharmacy providers, members and brokers) and internal team members for all outpatient medical benefit inquires. The Pharmacist Consultant will report to the Manager of Medical Benefit Drug Utilization. In...

  • Pharmacist, Consultant

    3 weeks ago

    Rancho Cordova, United States Blue Shield of California Full time

    Your Role The Pharmacy Services Drug Utilization Management team provides efficient and accurate responses to external customer (physicians, office staff, pharmacy providers, members and brokers) and internal team members for all outpatient medical benefit inquires. The Pharmacist Consultant will report to the Manager of Medical Benefit Drug Utilization. In...

  • Pharmacist, Consultant

    3 weeks ago

    Rancho Cordova, United States Blue Shield Of California Full time

    Your Role The Pharmacy Services Drug Utilization Management team provides efficient and accurate responses to external customer (physicians, office staff, pharmacy providers, members and brokers) and internal team members for all outpatient medical benefit inquires. The Pharmacist Consultant will report to the Manager of Medical Benefit Drug Utilization. In...

  • Pharmacist, Consultant

    3 weeks ago

    Rancho Cordova, United States Blue Shield of California Full time

    Your Role The Pharmacy Services Drug Utilization Management team provides efficient and accurate responses to external customer (physicians, office staff, pharmacy providers, members and brokers) and internal team members for all outpatient medical benefit inquires. The Pharmacist Consultant will report to the Manager of Medical Benefit Drug Utilization. In...

  • Pharmacist, Consultant

    1 week ago

    Rancho Cordova, United States Blue Shield of California Full time

    Your RoleThe Pharmacy Services Drug Utilization Management team provides efficient and accurate responses to external customer (physicians, office staff, pharmacy providers, members and brokers) and internal team members for all outpatient medical benefit inquires. The Pharmacist Consultant will report to the Manager of Medical Benefit Drug Utilization. In...

  • Pharmacist, Consultant

    2 weeks ago

    Rancho Cordova, United States Blue Shield Of California Full time

    Your Role The Pharmacy Services Drug Utilization Management team provides efficient and accurate responses to external customer (physicians, office staff, pharmacy providers, members and brokers) and internal team members for all outpatient medical benefit inquires. The Pharmacist Consultant will report to the Manager of Medical Benefit Drug Utilization. In...

  • Pharmacist Consultant

    3 weeks ago

    Rancho Cordova, United States Blue Shield Of California Full time

    Your Role The Pharmacy Services Drug Utilization Management team provides efficient and accurate responses to external customer (physicians, office staff, pharmacy providers, members and brokers) and internal team members for all outpatient medical benefit inquires. The Pharmacist Consultant will report to the Manager of Medical Benefit Drug Utilization. In...

  • Pharmacist, Consultant

    1 week ago

    Rancho Cordova, CA, United States Blue Shield of California Full time

    Your Role The Pharmacy Services Drug Utilization Management team provides efficient and accurate responses to external customer (physicians, office staff, pharmacy providers, members and brokers) and internal team members for all outpatient medical benefit inquires. The Pharmacist Consultant will report to the Manager of Medical Benefit Drug Utilization. In...

  • Distribution Pharmacist

    7 hours ago

    Fresno, CA, United States Rx relief Full time

    Job DescriptionJob DescriptionAttention Pharmacists!!Are you ready for a great new job in Central Valley, CA?With a pay of $65, Rx relief is looking for the right person to fill a Distribution Pharmacist & Acute Care Pharmacist position right now.Job Title: Distribution Pharmacist & Acute Care PharmacistCompany Information: Rx relief is a leading staffing...

  • Pharmacist

    1 month ago

    Mexico, MO, United States Jackson Street Drug Full time

    Jackson Street Drug is looking for a staff pharmacist. Additional experience as a clinical pharmacist, staff pharmacist, or pharmacist consultant with proper licensing will also be considered. Experience as an MTM pharmacist may also be considered. Responsibilities include, but are not limited to, verifying prescriptions, supervising pharmacy technicians,...

  • Pharmacist

    2 weeks ago

    Mexico, MO, United States Jackson Street Drug Full time

    Jackson Street Drug is looking for a staff pharmacist. Additional experience as a clinical pharmacist, staff pharmacist, or pharmacist consultant with proper licensing will also be considered. Experience as an MTM pharmacist may also be considered. Responsibilities include, but are not limited to, verifying prescriptions, supervising pharmacy technicians,...

  • Pharmacist

    3 weeks ago

    Mexico, MO, United States Jackson Street Drug Full time

    Jackson Street Drug is looking for a staff pharmacist. Additional experience as a clinical pharmacist, staff pharmacist, or pharmacist consultant with proper licensing will also be considered. Experience as an MTM pharmacist may also be considered. Responsibilities include, but are not limited to, verifying prescriptions, supervising pharmacy technicians,...

  • Pharmacy Business Consultant

    6 days ago

    Rancho Cordova, California, United States Blue Shield of California Full time

    Your Role The Clinical Pharmacy Operations division is dedicated to the formulation, execution, coordination, and evaluation of pharmacy strategies aimed at delivering high-quality and cost-effective care to members of Blue Shield of California. The Experienced Business Analyst will report directly to the Senior Pharmacist Manager within the Clinical...

  • Hospital Pharmacist

    1 day ago

    Williston, ND, United States Clinical Management Consultants Full time

    An exciting opportunity has just opened up for a Hospital Pharmacist at a well-respected Community Hospital in North Eastern Montana! This Community Hospital is known for its patient-first commitment to quality care and has a reputation for treating patients and families with dignity and respect. This hospital offers numerous services to the community and...