The Clinical Pharmacist is responsible for promoting appropriate and/or efficient utilization review of prescription drug claims among BCBSM participating physicians. This position is also responsible for the education of physicians and influencing of prescribing patterns to reduce BCBSM's drug benefit payout and improve the quality of the benefits as it relates to our members. The incumbent serves as the liaison to the Medical Policy department assisting with the development of medical policy as it applies to drugs.
- Provides clinical coverage review for medication requests
- Develops, implements, and updates Drug Utilization Review/Due Programs.
- Provides effective and efficient communication of pharmacotherapy issues.
- Develops and implements a variety of behavior modification principles to influence physicians to prescribe appropriately.
- Identifies target physicians, establishes credibility and utilizes both verbal and written communications to modify behavior.
- Serves as the key clinical support person for researching prescription drug inquiries.
- Develops, implements and monitors the Corporate Drug Information Center.
- Develops, implements and continually updates physician and patient educational materials.
- Supports Drug Formulary development and serves on the BCBSM P and T Committee.
- Serves as liaison to medical Policy assisting with the development of medical policy as it applies to drugs.
- Participate in clinical and operational process improvement and cost savings opportunities. Support review and resolution of clinical and compliance grievances and appeals.
- Support clinical initiatives related to NCQA, HEDIS, CAHPS and STAR measures. Adhere to Pharmacy Policies and Procedures.
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. EMPLOYMENT QUALIFICATIONS: EDUCATION:
Bachelor's degree or Doctorate in Pharmacy. Current unrestricted Michigan Pharmacy License required. EXPERIENCE:
Three years of experience consulting with physicians on pharmaceutical issues or completion of an accredited American Society of Health-System Pharmacists/Academy of Managed Care Pharmacy, AMCP/ASHP, Managed Care Pharmacy or Pharmacy Practice Residency. Drug Information Specialist with proven background and skills may also be considered. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
- Must have superior oral and written communication skills and expertise in the design of presentations. The incumbent must have the ability to obtain and devise relevant data and information from existing MIS Systems.
- An understanding or knowledge of drug claims processing systems and/or medical information systems is preferred.
- Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
- Ability to write reports, business correspondence, and procedure manuals.
- Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
Work is performed in an office setting with no unusual hazards.
The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.
We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an \"at will\" basis. Nothing herein is intended to create a contract.
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