BlueCross BlueShield of Tennessee Clinical Pharmacist II in Chattanooga, Tennessee
The Clinical Pharmacist II is responsible for managing various clinical pharmacy programs including but not limited to those programs involving medication adherence, medication therapy management (MTM), polypharmacy, controlled substance monitoring and/or high-risk medication monitoring. The Clinical Pharmacist II will be responsible for reviewing pharmacy related utilization across all lines of business, preparing recommendations for prescribers and members in order to modify prescription utilization and optimize therapeutic outcomes. He/she will participate in direct contact with prescribers to present recommendations and function as a contact point for case/disease management staff for pharmacy related issues. This individual will support the utilization review process for case and risk management related to the utilization of pharmaceuticals. The Clinical Pharmacist II will also participate in the review of medication-related pre-determinations, drug prior authorizations, pharmacy appeals and member grievances focused on medications. The Clinical Pharmacist II will manage clinical staff responsible for day to day activities of pharmacy care management programs.
Job Duties & Responsibilities
- Responsible for day to day management of pharmacy care management programs including but not limited to medication adherence, medication therapy management (MTM), polypharmacy, controlled substance monitoring and high risk medication monitoring
- Responsible for reviewing member profile for signs of overutilization, duplication of therapy, multiple prescribers, and multiple pharmacies
- Provides recommendations in order to develop and implement improved clinical procedures and best practices to minimize and prevent future adverse medication events
- Develops as an individual, or as part of a clinical team, or in conjunction with the medical policy department and/or the PBM and presents clinical evaluations, pipeline surveillance data, formulary reviews and presentations to the corporate P & T Committee upon request
- Assists in preparation for the corporate Pharmacy and Therapeutics (P&T) Committee meetings
- Provides clinical medication therapy evaluations and recommendations to members and providers regarding the safe appropriate and cost-effective use of medication
- Assists in planning and implementing new and revised clinical programs and services
- Oversees designated key support personnel to identify and improve process issues and/or quality measures and increase workflow efficiencies
- Serves as a clinical resource and drug information specialist to medical, pharmacy, & nursing staff as well as to allied healthcare providers internally and externally
- Reviews and develop pharmaceutical treatment recommendations for case management referrals
- Supports Manager of Clinical Pharmacy Operations in the review of medication-related pre-determination requests, drug prior authorizations, pharmacy appeals and member grievances focused on medications.
- Assists the Director of Clinical Pharmacy in the advanced pharmacy practice rotations for fourth year pharmacy school students
- Review the draft medical policies and provide any recommendations for change to these policies to the Medical Policy staff
- Provide pharmacy-related educational in-services to BCBST nurses as requested
- Responds to prescriber, pharmacy provider, member appeals, grievances and complaints related to the provision of pharmaceutical services within established time periods
- Assists in the development and on-going review of the commercial, ambulatory formularies as well the development and maintenance of medial policies related to specialty pharmaceuticals for all lines of business (Commercial and Government)
- Supports pharmacy effort to achieve accreditation by external agencies
- Supports pharmacy related medical management operations to achieve corporate goals for pharmacy
- Serves on internal committees and/or workgroups and completes special projects as assigned
- Direct supervisory responsibility of clinical pharmacists and/or support staff
- Participates in local, state, and/or national professional practice organizations
- Licensed in Tennessee to practice pharmacy, or eligible for licensure in the state of Tennessee to practice pharmacy
- Doctor of Pharmacy (PharmD) degree required, with completion of a specialized residency program (e.g. managed care, drug information, pharmacotherapy, etc) or postgraduate training, preferred
- Minimum of 6 years clinical experience (broad scope preferred) required, and/or completion of 1 year residency and/or board certification required.
- Familiarity with computers and diverse software packages.
- Statistics and research design acumen.
- Solid understanding of regulatory guidelines (FDA, NCQA, EQRO) required.
- Excellent communication and presentation skills, both verbal and written are essential.
- Competency in compendia navigation and research
Job Specific Requirements:
BBEX 13 T60215 EX/CAP Grd 13
Number of Openings Available:
BCBST BlueCross BlueShield of Tennessee, Inc.
BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or membership in a historically under-represented group.
BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.
Tobacco-Free Hiring Statement
To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products in any form in Tennessee and where state law permits. A tobacco-free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a tobacco/nicotine test. An individual whose test result is positive for tobacco/nicotine will be disqualified from employment and the job offer will be withdrawn. Individuals who fail the tobacco/nicotine screening will be permitted to reapply for employment after 6 months, if tobacco/nicotine-free.
Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.
As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health for over 65 years. More than that, we're your neighbors and friends – fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow.