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. 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; complete projects as assigned
  • Support the operational and clinical implementation of medication policies for drugs provided under the medical benefit, for 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 timeframes
  • 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
  • Requires working at least one weekend per month and company holidays as needed to ensure regulatory compliance with prior authorization turnaround times
  • Thorough knowledge of therapeutic use of medications
  • Excellent oral and written communication skills

Pay Range:

The pay range for this role is: $118,800.00 to $178,200.00 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.



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

    Your Role The Prior Authorization (PA) team utilizes clinical knowledge to review authorization requests for coverage under the outpatient pharmacy benefit. The Pharmacist, Consultant will work as part of the pharmacy benefit Prior Authorization (PA) team to support the Blue Shield of California (BSC) Pharmacy and Therapeutics Committee (P&T) by ensuring...


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

    Your Role The Prior Authorization (PA) team utilizes clinical knowledge to review authorization requests for coverage under the outpatient pharmacy benefit. The Pharmacist, Consultant will work as part of the pharmacy benefit Prior Authorization (PA) team to support the Blue Shield of California (BSC) Pharmacy and Therapeutics Committee (P&T) by ensuring...


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

    Your Role The Prior Authorization (PA) team utilizes clinical knowledge to review authorization requests for coverage under the outpatient pharmacy benefit. The Pharmacist, Consultant will work as part of the pharmacy benefit Prior Authorization (PA) team to support the Blue Shield of California (BSC) Pharmacy and Therapeutics Committee (P&T) by ensuring...


  • Rancho Cordova, United States Blue Shield Of California Full time

    Your Role The Prior Authorization (PA) team utilizes clinical knowledge to review authorization requests for coverage under the outpatient pharmacy benefit. The Pharmacist, Consultant will work as part of the pharmacy benefit Prior Authorization (PA) team to support the Blue Shield of California (BSC) Pharmacy and Therapeutics Committee (P&T) by ensuring...


  • 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....


  • 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....


  • 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....


  • 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....


  • 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...


  • Rancho Cordova, United States Blue Shield Of California Full time

    Your Role Remember to check your CV before applying Also, ensure you read through all the requirements related to this 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...


  • 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....


  • 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....


  • 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....


  • 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....


  • 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....

  • Pharmacist

    4 weeks ago


    Burbank, CA, United States First Aid Pharmacy Full time

    Company DescriptionFirst Aid Pharmacy is a long-term care pharmacy business located in Burbank, California. We are privately owned and are continuing to grow each year to provide upmost service. Our pharmacy provides daily medication deliveries and consulting services to nursing and assisted living facilities and hospice residents. We are passionate about...

  • Clinical Pharmacist

    2 days ago


    Rancho Cucamonga, CA, United States HealthCare Talent Full time

    Clinical Pharmacist Position Summary Under the direction of the Manager, Clinical Pharmacist, the Clinical Pharmacist is responsible for the daily operation of clinical programs and prior authorization activities. The Clinical Pharmacist should demonstrate the ability to participate in multidisciplinary teams to provide comprehensive care to Members through...

  • Pharmacist in Charge

    2 weeks ago


    Avalon, CA, United States AVALON MEDICAL DEVELOPMENT CORPORATION Full time

    We are seeking a dedicated and experienced Pharmacist in Charge to join our team at Leo's Drug Store. As the Pharmacist in Charge, you will be responsible for overseeing all pharmacy operations, ensuring compliance with all regulatory requirements, providing exceptional patient care, and managing a pharmacy staff. Must be willing to relocate to Avalon for...

  • Relief Pharmacist

    4 weeks ago


    Sheboygan, WI, United States Meijer Full time

    As our Relief Pharmacist, you play a personal role within your community by ensuring that your patients receive medication and care that they need. you must practice the profession of pharmacy in an environment that by philosophy and policy, promote patient care and education including patient consultation consultations and immunizations. Mentor, train and...


  • Vandalia, OH, United States Dayton Children's Hospital Full time

    Facility:Dayton Children's - Main CampusDepartment:Retail PharmacySchedule:Part timeHours:16Job Details:Main Campus pharmacists dispense pharmaceutical products for patients on the Outpatient side of the hospital. The pharmacist is responsible for reviewing prescriptions, verifying correct dose, and final verification and dispensing of the medication. The...