at Blue Cross of Idaho in Meridian, Idaho, United States
Job Description
Blue Cross of Idaho (BCI) is seeking a Clinical Pharmacist to support the clinical and financial objectives of the Pharmacy Department, working to maintain the mission of Blue Cross of Idaho in serving the communities of Idaho and beyond. The pharmacist will perform day-to-day clinical pharmacy functions including prior authorization reviews, medical policy and prior authorization coverage criteria review, as well as provide support for the Pharmacy and Therapeutics Committee (P&T) and Medical Policy Committee. Identify and communicate opportunities to improve the appropriate and cost-effective use of medications. Support staff training and development. Serve as a resource/liaison to internal and external partners. The pharmacist will oversee and addresses complex issues that require critical thinking and in-depth analysis of variable factors.Hybrid work schedule is supported. #LI-Hybrid
We're looking for Clinical Pharmacist with:
- Experience: Three years ; OR Post-graduate pharmacy residency
- Education: Doctor of Pharmacy (Pharm D) from an accredited School of Pharmacy; OR Registered Pharmacist (RPh)
- Certifications/Licenses: Idaho Pharmacist License or must obtain with 120 of hire
What a day of a Clinical Pharmacist would look like:
- Responsible for timely, compliant, and accurate review of utilization management (ie. prior authorizations) coverage determinations and appeals.
- Serve as a formulary and drug information resource, assisting the pharmacy review team and other departments with questions regarding prior authorizations and/or drug coverage.
- Acts as a liaison when appropriate between BCI and its customers (ex. members, providers, and vendors).
- Serves as the formulary and medication coverage expert, helping to ensure Blue Cross of Idaho is compliant with coverage determination and appeal processes.
- Develops, implements, and maintains pharmacy cost control and quality initiatives under the direction of leadership.
- Monitors drug utilization and assists leadership team in understanding quality and cost control issues related to pharmacy.
- Identifies and implements programs to improve clinical outcomes stemming from medication selection, utilization, and adherence. Analysis of new-to-marked medications, including detailed evaluation of evidence and drug monograph development for presentation to, and review by, BCI P&T committee.
- Analysis and review of clinical coverage criteria for development of new, and maintenance of existing medical policies and coverage criteria.
- Processes are compliant with pharmacy-related regulatory standards (ex NCQA, CMS).
As of the date of this posting, a good faith estimate of the current pay range is $115,898 to $173,846. The position is eligible for an annual incentive bonus (variable depending on company and employee performance).
The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, travel requirements, internal equity, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer.
We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program.
We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies.
Reasonable accommodations
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. To view full details and how to apply, please login or create a Job Seeker account
