Clinical Pharmacist, Medicare Clinical Programs Specialist

2 weeks ago


Hingham, Montana, United States Blue Cross Blue Shield of Massachusetts Full time

About the Role:

The Clinical Pharmacist, Medicare Clinical Programs is a key member of our team, responsible for working with prescribers, members, and an interdisciplinary team to enhance the care of BCBSMA members with high-cost or multiple chronic co-morbid conditions requiring complex medication regimens.

This role will support care management with identifying and resolving drug-related problems for participants, and assist the Pharmacy Department in the measurement of program objectives and outcomes for the program.

The clinical pharmacist will also be responsible for continued education for internal teams on various pharmacy-related topics, including Stars.

Your Key Responsibilities:

  • Provide care management in reviewing and evaluating drug information for adherence, disease-specific case management collaboration, medication reconciliation, and polypharmacy to identify potential medication therapy problems and recommend appropriate solutions for identified patients.
  • Communicate directly with members to help identify and answer any drug-related questions as needed.
  • Provide in-service education on pharmacy-related topics to care management staff and other associated teams.
  • Supports and participates in Medicare Case Management rounds.
  • Conduct comprehensive medication reviews for eligible members.
  • Educate patients about their medications, conditions, and pharmacy benefits to achieve optimal participant care outcomes.
  • Collaborate with Pharmacy Benefit Manager (PBM) clinical team and internal BCBSMA departments to align priorities and execute initiatives.
  • Assist in the creation and delivery of presentations and communications for various internal and external projects and meetings.
  • Engage and follow-up with providers on identified interventions.
  • Special projects as assigned.

What We're Looking For:

  • Unrestricted current and valid license to practice pharmacy in the state of Massachusetts.
  • Graduate of an ACPE-accredited School of Pharmacy with a PharmD or related work experience.
  • Minimum of 2-3 years' experience functioning as a clinical pharmacist in a managed care or hospital setting.
  • Experience in direct supervision of technical support staff for clinical and/or service and operational programs is desirable.
  • Intermediate to advanced proficiency in standard computational office-suite applications, including Microsoft Word, Excel, and PowerPoint, and relational database manipulation is highly preferred.

Why Blue Cross Blue Shield of Massachusetts?

We are committed to investing in your development and providing the necessary resources to enable your success. We are dedicated to creating a refreshing and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path.

We take pride in our diverse, community-centric, wellness-focused culture and believe every member of our team deserves to enjoy a positive work-life balance.



  • Hingham, Montana, United States Mass General Brigham Full time

    Job Title: Nurse Triage SpecialistJob Summary: We are seeking a skilled Nurse Triage Specialist to join our Cardiology team at Mass General Brigham. The successful candidate will be responsible for handling patient interactions via telephone, providing advice in accordance with clinical protocols, and coordinating proper disposition.Key...

  • Physical Therapist

    2 weeks ago


    Hingham, Montana, United States Hingham Physical Therapy Inc Full time

    Job DescriptionWe are seeking a highly skilled Physical Therapist to join our team at Hingham Physical Therapy Inc. Our outpatient clinic offers a dynamic and supportive work environment, with a focus on providing exceptional patient care.Key Responsibilities:Assess and treat patients with various physical therapy needsDevelop and implement personalized...


  • Hingham, Montana, United States South Shore Health Full time

    Job SummarySouth Shore Health is seeking a skilled Occupational Therapist to join our Outpatient Practice team. As an Occupational Therapist, you will play a vital role in helping patients achieve their goals and regain independence in their daily lives.Key Responsibilities• Evaluate and treat patients with a variety of sports, orthopedic, and physical...


  • Hingham, Montana, United States Soliant Full time

    Job Summary:We are seeking a highly skilled Speech-Language Pathologist to join our team at Soliant in Hingham, MA. As a Speech-Language Pathologist, you will be responsible for providing speech therapy services to students in a school setting.Responsibilities:Provide speech therapy services to students with communication disordersDevelop and implement...


  • Hingham, Montana, United States Soliant Full time

    ESY Speech-Language Pathologist OpportunityWe are seeking a dedicated and passionate Speech-Language Pathologist to provide speech and language therapy services to students during the Extended School Year (ESY) program.Key Responsibilities:Assessment and Evaluation: Conduct comprehensive speech and language assessments for students to identify their needs...

  • School Psychologist

    2 weeks ago


    Hingham, Montana, United States Epic Special Education Staffing Full time

    About Epic Special Education StaffingWe are a leading provider of special education staffing solutions, dedicated to connecting talented professionals with schools and districts in need of exceptional support. Our team is passionate about making a positive impact on the lives of students and families.Position OverviewWe are seeking a highly skilled and...


  • Hingham, Montana, United States Apple Full time

    As a Business Expert at Apple, you will play a key role in helping business professionals and entrepreneurs discover the power of Apple solutions. You will connect with customers to understand their needs and provide personalized recommendations to help them achieve their goals.With your passion for business and technology, you will work closely with the...

  • Lead Line Cook

    2 weeks ago


    Hingham, Montana, United States Tatte Bakery & Cafe Full time

    At Tatte Bakery & Cafe, we're seeking a skilled Lead Line Cook to join our culinary team. As a guardian of our commitment to quality and craftsmanship, you'll ensure that every dish that leaves our kitchen meets our high standards. As an expeditor and quality control specialist, you'll validate that all plates, allergies, and modifications meet our company...


  • Hingham, Montana, United States All Points Licensed Behavior Analysts, PLLC Full time

    Job Summary:We are seeking a highly skilled Direct Service Provider/RBT to join our team at All Points Licensed Behavior Analysts, PLLC. As a key member of our staff, you will play a vital role in providing high-quality ABA services to children with autism.Our home and center-based programs offer a supportive and collaborative environment where you can grow...


  • Hingham, Massachusetts, United States Blue Cross Blue Shield of Massachusetts Full time

    Job SummaryWe are seeking a highly skilled Clinical Pharmacist to join our team at Blue Cross Blue Shield of Massachusetts. As a Clinical Pharmacist, you will play a critical role in enhancing the care of our members with high-cost or multiple chronic co-morbid conditions requiring complex medication regimens.Key ResponsibilitiesWork with prescribers,...


  • Hingham, United States BlueCross & BlueShield of Massachusetts Full time

    The Pharmacy Operations Clinical Pharmacist Manager manages and directs clinical staff in the day to day clinical operational UM activities to ensure that all Commercial (Pharmacy and Medical benefits) and Medicare Advantage Part D coverage determina Clinical, Operations, Pharmacy, Pharmacist, Manager, Operations Manager, Insurance, Healthcare


  • Hingham, Massachusetts, United States BlueCross & BlueShield of Massachusetts Full time

    Job SummaryThe Pharmacy Operations Clinical Pharmacist Manager at BlueCross & BlueShield of Massachusetts oversees the day-to-day clinical operational activities to ensure compliance with Commercial and Medicare Advantage Part D coverage determinations. This role involves managing and directing clinical staff to achieve operational excellence in pharmacy...


  • Hingham, United States Blue Cross Blue Shield of Massachusetts Full time

    Ready to help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Intake Specialist is responsible for processing telephonic and fax notifications, referrals and requests for authorization from members, facilities and physician offices.The Clinical Intake Specialist focuses on building and updating referrals and authorization...


  • Hingham, Massachusetts, United States Blue Cross Blue Shield of Massachusetts Full time

    Transform Healthcare with UsWe're seeking a dedicated Medicare Quality Assurance Supervisor to join our team at Blue Cross Blue Shield of Massachusetts. As a key member of our pharmacy operations team, you will play a vital role in ensuring the accuracy and quality of Medicare claims.Your Key Responsibilities:Review Medicare cases before finalization to...


  • Hingham, Massachusetts, United States Blue Cross Blue Shield of Massachusetts Full time

    Job SummaryBlue Cross Blue Shield of Massachusetts is seeking a highly skilled Clinical Intake Specialist to join our team. As a Clinical Intake Specialist, you will play a critical role in processing telephonic and fax notifications, referrals, and requests for authorization from members, facilities, and physician offices.Key ResponsibilitiesHandle...


  • Hingham, Massachusetts, United States Blue Cross Blue Shield of Massachusetts Full time

    About the RoleWe are seeking a highly skilled Clinical Intake Specialist to join our team at Blue Cross Blue Shield of Massachusetts. As a Clinical Intake Specialist, you will play a critical role in processing telephonic and fax notifications, referrals, and requests for authorization from members, facilities, and physician offices.Key...


  • Hingham, Massachusetts, United States Blue Cross Blue Shield of Massachusetts Full time

    About the RoleWe are seeking a highly skilled Clinical Intake Specialist to join our team at Blue Cross Blue Shield of Massachusetts. As a key member of our Clinical Intake team, you will be responsible for processing telephonic and fax notifications, referrals, and requests for authorization from members, facilities, and physician offices.Key...


  • Hingham, Massachusetts, United States Blue Cross Blue Shield of Massachusetts Full time

    Transform Healthcare with UsAt Blue Cross Blue Shield of Massachusetts, we're committed to delivering exceptional healthcare services. As a Medicare Quality Assurance Supervisor, you'll play a vital role in ensuring the accuracy and quality of Medicare cases. Your expertise will help us transform healthcare for all.Your Key Responsibilities:Review Medicare...


  • Hingham, Massachusetts, United States Blue Cross Blue Shield of Massachusetts Full time

    Transform Healthcare with UsAre you ready to make a meaningful impact in the healthcare industry? We're seeking a highly skilled Clinical Consultant, Population Health to join our team at Blue Cross Blue Shield of Massachusetts. In this role, you'll have the opportunity to work closely with our clients to develop and implement population health strategies...


  • Hingham, Massachusetts, United States LifeStance Health Full time

    We are seeking a skilled Clinical Psychologist to join our team at LifeStance Health. As a Clinical Psychologist, you will be responsible for providing evidence-based treatment interventions for adults and children struggling with various mental health issues. Our ideal candidate will have a strong background in behavioral health and be skilled in working...


  • Hingham, Massachusetts, United States Blue Cross Blue Shield of Massachusetts Full time

    Transforming Healthcare TogetherAt Blue Cross Blue Shield of Massachusetts, we're committed to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path. We're seeking a talented Clinical Consultant, Population Health to join our team and help us transform healthcare for...


  • Hingham, United States Linden Ponds by Erickson Senior Living Full time

    Location:Linden Ponds by Erickson Senior LivingJoin our team as the Clinical Manager is an active member of the clinical leadership team who is responsible for the assessment, coordination, implementation, and evaluation of the delivery of safe and effective person-centered care in their assigned neighborhood. The Clinical Manager will also facilitate,...

  • Clinical Manager, RN

    2 weeks ago


    Hingham, United States Linden Ponds by Erickson Senior Living Full time

    Location:Linden Ponds by Erickson Senior Living Join our team as the Clinical Manager is an active member of the clinical leadership team who is responsible for the assessment, coordination, implementation, and evaluation of the delivery of safe and effective person-centered care in their assigned neighborhood. The Clinical Manager will also facilitate,...

  • Clinical Manager, RN

    2 weeks ago


    Hingham, United States Linden Ponds by Erickson Senior Living Full time

    Location:Linden Ponds by Erickson Senior LivingJoin our team as the Clinical Manager is an active member of the clinical leadership team who is responsible for the assessment, coordination, implementation, and evaluation of the delivery of safe and effective person-centered care in their assigned neighborhood. The Clinical Manager will also facilitate,...

  • Clinical Manager, RN

    2 weeks ago


    Hingham, United States Linden Ponds by Erickson Senior Living Full time

    Location:Linden Ponds by Erickson Senior LivingJoin our team as the Clinical Manager is an active member of the clinical leadership team who is responsible for the assessment, coordination, implementation, and evaluation of the delivery of safe and effective person-centered care in their assigned neighborhood. The Clinical Manager will also facilitate,...

  • Clinical Manager, RN

    2 weeks ago


    Hingham, United States Linden Ponds by Erickson Senior Living Full time

    Job DescriptionJob DescriptionLocation:Linden Ponds by Erickson Senior LivingJoin our team as the Clinical Manager is an active member of the clinical leadership team who is responsible for the assessment, coordination, implementation, and evaluation of the delivery of safe and effective person-centered care in their assigned neighborhood. The Clinical...


  • Hingham, United States Linden Ponds by Erickson Senior Living Full time

    Location:Linden Ponds by Erickson Senior LivingJoin our team as the Clinical Manager is an active member of the clinical leadership team who is responsible for the assessment, coordination, implementation, and evaluation of the delivery of safe and effective person-centered care in their assigned neighborhood. The Clinical Manager will also facilitate,...


  • Hingham, Massachusetts, United States Erickson Living Full time

    Job SummaryWe are seeking a skilled Licensed Practical Nurse (LPN)/Licensed Vocational Nurse (LVN) to join our team at Linden Ponds by Erickson Senior Living. As a LPN/LVN, you will be responsible for providing high-quality clinical care to our residents, ensuring their physical, spiritual, and emotional needs are met.Key ResponsibilitiesAssess and evaluate...

  • Medical Assistant

    6 days ago


    Hingham, United States South Shore Health Full time

    Job Description SummaryThe Medical Assistant is responsible for supporting the practice with overall responsibility for maintaining efficiency of patient flow. Clinical duties include but are not limited to maintaining universal precautions; rooming patients, taking necessary vital signs and measurements, perform phlebotomy as needed, administering vaccines,...