Your Role
The Medication Policy team is primarily responsible for supporting the Blue Shield of California (BSC) Pharmacy and Therapeutics (P&T) Committee process and supports the operational components of the Drug Authorization Program. In this role, the Pharmacist, Principal is critical in ensuring that evidence based clinical criteria approved by the BSC Pharmacy and Therapeutics Committee are implemented operationally in order to provide a quality and cost-effective care. The Pharmacist, Principal will report to the Senior Manager, Pharmacist.
Your Work
In this role, you will:
- Develop, analyze & monitor prescription drug, medical claims, and program data to identify opportunities to improve quality and cost of healthcare and to monitor/report performance and outcomes
- Develop project proposals for identified opportunities and support implementation
- Serve as a BSC Pharmacy Services contact and subject matter expert to stakeholders, and manage external relationships (vendors, clients) related to assigned work
- Support the operational implementation and maintenance of medication policies for drugs in the pharmacy and medical benefit
- Support the configuration of clinical rules in the automated prior authorization system for both pharmacy and medical benefit drugs
- Ensure compliance with various regulatory and quality accreditation requirements around drug utilization management in order to support safe, efficacious, and cost-effective prescribing
- Provide support for the development and maintenance of BSC drug formulary for all product lines
- Provide pharmacotherapy expertise for the pharmacy program by supporting the Pharmacy and Therapeutics Committee, drug formulary, prior authorization, drug utilization review and physician reporting programs
- Assist with the monitoring, tracking, and trending of coverage decisions derived from the Blue Shield P&T Committee formulary & utilization management decisions
Your Knowledge and Experience
- Requires a Doctor of Pharmacy (PharmD) degree
- Requires a currently active and unrestricted California Registered Pharmacist (RPh) license
- Requires 4 years of experience in clinical pharmacy
- Thorough clinical knowledge regarding therapeutic use of drugs
- Excellent oral and written communication skills
- Proficiency with Microsoft related software applications