Consultant Pharmacist - Part-Time

Pharmacist, Consultant
The Prior Authorization (PA) team utilizes clinical knowledge to review authorization requests for coverage under the outpatient pharmacy benefit. The Pharmacist, Consultant will work as part of the pharmacy benefit Prior Authorization (PA) team to support the Blue Shield of California (BSC) Pharmacy and Therapeutics Committee (P&T) by ensuring that evidence based clinical decisions are implemented appropriately to provide a high-quality and cost-effective pharmacy benefit. The Pharmacist, Consultant (Drug Utilization Review Pharmacist) will report to the Drug Utilization Review (DUR) Pharmacist Manager.
Support the clinical and operational implementation of P&T approved policies for the pharmacy benefit, for both the Commercial and Medicare lines of business
Apply clinical expertise to PA reviews and work collaboratively with the PA and Call Center Teams to support access to safe, efficacious, and medically necessary medications
Operate in compliance with all regulatory and accreditation requirements to ensure all requests are reviewed within regulatory required timeframes
Serve as a resource to internal and external constituents regarding the Blue Shield drug formulary, medication policies and appropriate drug use
Embrace BSC values by answering clinical and operational questions, participating in group discussions, and supporting other team members while working towards a collective goal
Use clear and concise communications and on-brand messaging when communicating with providers or members
Follow all corporate policies and procedures
Operate in compliance with all regulatory and accreditation requirements, and corporate policies and procedures regarding the support access to safe, efficacious, and medically necessary medications
Assist in preparing materials for audits and reports; complete projects as assigned
Requires a Doctor of Pharmacy (PharmD) degree
Requires a currently active and unrestricted California Registered Pharmacist (RPh) license
Requires at least 2 years of experience in clinical pharmacy
Previous experience working at a health plan is preferred
Prior authorization experience is preferred
Hybrid Virtual Work
This role allows employees to work virtually full-time, however employees will be expected to come into the office based on business needs.
Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. News Best Company to work for, a Deloitte U.Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!
We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. For most teams, this means coming into the office two days per week.
Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
Job Category Pharmacy Services