Health Plan Pharmacist - Remote

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements: Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month Onsite: daily onsite requirement based on the essential functions of the job Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one‑on‑ones, training, and team building Please note that onsite requirements may change in the future, based on business need and job responsibilities. Most employees should expect onsite requirements at a minimum of once per week. This position is remote within the state of AZ only. This remote work opportunity requires residency and work to be performed within the State of Arizona. Purpose of the job This position is responsible for maintaining and supporting the Medicare and/or Medicaid formulary and providing clinical and economic data necessary to make formulary decisions. This position acts as a pharmacy resource for network physicians, health plan members, medical services, care management, and member service staffs as well as other internal partners. It assists in performing all CMS mandated quality and compliance activities. Serves as a pharmacy topic educator and training resource to Medicare and/or Medicaid health plan departments and personnel. This position has the latitude for independent decision‑making within the limits of acceptable standards of pharmacy practice and state and federal laws. It requires interactions at all levels of staff and management. External interactions include network physicians, and health plan members, etc. Qualifications Required Qualifications 5 years or more as a practicing pharmacist 3 years of experience in the managed care pharmacy field 2 years of direct prior authorization experience 2 years of managed care/health plan and/or pharmacy benefits experience Required Education Doctor of Pharmacy (Pharm.D) degree Required Licenses Active, current and unrestricted State of Arizona pharmacist license Required Certifications N/A Preferred Qualifications Preferred Work Experience Medicare Part D experience highly desirable Preferred Education Pharm.D. with residency or fellowship preferred Preferred Licenses N/A Preferred Certifications Geriatric certification Essential job functions and responsibilities Provides and assists with the management of pharmacy services to Medicare and/or Medicaid health plan members that is consistent with acceptable standards of pharmacy practice and applicable regulations and guidance. Assists in defining, implementing, and managing Medicare and/or Medicaid health plan pharmacy programs including the medication therapy and drug utilization management. Directly interfaces with Medicare and/or Medicaid members, and network providers concerning pharmacy issues and programs. Designs and delivers staff/community educational programs and provides individual medication counseling, if appropriate. Produces pharmacy utilization reports as well as clinical and economic data to the health plan to assist in pharmacy benefit utilization analysis. Conducts audits and produces reports that can be utilized by the care management, quality, and compliance departments to evidence quality pharmacy services and meets Medicare and/or Medicaid requirements. Applies the principles of continuous quality improvement consistent with job expectations. Incorporates quality improvement principles into other activities and projects (i.e., data collection, documentation). Develops criteria for drug use evaluations, medication use indicators and disease‑based evaluations. May be assigned to create data extracts of the pharmacy claims system and support ad‑hoc report requirements for health plan pharmacy utilization management and audit functions. Performs all functions according to established policies, procedures, regulatory, and accreditation requirements, as well as applicable professional standards. Provides all customers with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day. Perform other duties as required Competencies Required Competencies Required Job Skills Proficient in critical literature evaluation skills, including evidence‑based medicine principles Excellent problem‑solving skills Strong written and verbal communications Intermediate PC proficiency Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones Intermediate skill in word processing, spreadsheet and database software Intermediate skill using departmental BCBSAZ and BCBSA software Required Professional Competencies Must have effective human relations and verbal/written communication skills and the ability to work collaboratively with community‑based practitioners and the senior population Must have an understanding of the interrelationships of health plan pharmacy components, members, and providers Proficiency with PC based productivity tools Needs analytical ability to support decision-making; organizational ability to manage multiple tasks and projects by established deadlines Flexible skills in an operationally changing environment, with drive for results based on planned objectives Strong customer service skills Interpersonal skills that allow for harmonious relationships with providers, members and coworkers Recognize strategic opportunities and use data to make timely and sound decisions Flexibility and willingness to adjust to shifting demands/priorities Required Leadership Experience and Competencies High standard of performance while pursuing aggressive goals Ability to lead by example Preferred Competencies Preferred Job Skills N/A Preferred Professional Competencies N/A Preferred Leadership Experience and Competencies N/A Our Commitment AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group. #J-18808-Ljbffr JobRx, Inc.