Clinical Pharmacist

1 week ago


Little Rock, Arkansas, United States Arkansas Blue Cross Full time
Job Summary

The Clinical Pharmacist - Utilization Management will play a crucial role in ensuring the effective management of pharmacy benefits and services for our members. This position requires a strong understanding of pharmacy practices, medical policies, and regulatory requirements.

Key Responsibilities
  • Conduct second-level reviews for medical and pharmacy benefit medication prior-authorizations, exceptions, and medical necessity reviews submitted to the plan.
  • Review and interpret coverage across all lines of business to determine the required review type.
  • Collaborate with requesting providers, corporate medical directors, and internal staff to determine whether a specific case presentation meets the criteria for approval.
  • Draft pharmaceutical medical criteria and perform other activities in support of the enterprise prior authorization program.
  • Implement pharmacy cost containment strategies and contribute to Enterprise-wide undertakings and commitments.
  • Uphold clinical integrity by staying up-to-date on medication information and contributing to the identification of pharmacy program best practices.
Requirements
  • Bachelor's degree in Pharmacy from an accredited college of pharmacy.
  • Current, unrestricted license in pharmacy in the state(s) where job duties are performed.
  • Minimum three (3) years' pharmacy practice experience.
  • Minimum three (3) years' experience in managed pharmacy care and drug utilization review preferred.
Security Requirements

This position is identified as level three (3). The integrity of information must be maintained as outlined in the company Administrative Manual. Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business.

Employment Type

Regular


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