Ready to help us transform healthcare? Bring your true colors to blue. 

The Clinical Pharmacist Reviewer reviews formulary exception, prior authorization and quantity limit exception requests from providers via phone and fax for the Retail Pharmacy, Medicare Advantage Part D, Home Infusion Therapy, and Medical Utilization Management benefits. The work schedule for this role is Saturday 8a-4p and four week days.

ROLE RESPONSIBILITIES:

• Participation in Prior Authorization, Formulary Exception, Step Therapy and Quality Care Dosing program implementation and management
• Support Pharmacy Operations analysts in executing day-to-day approvals and denials in order to maintain compliance with all regulatory requirements.
• Support product portfolio, including Medicare Part D which includes rotational weekend and holiday support for timely determinations.
• Support the Home Infusion Therapy, Specialty Pharmacy Network and Medical Utilization Management for pharmaceuticals programs
• Partner with clinical and non-clinical teams for staff training, facilitation of meetings and other ad hoc presentations.
• Participate in the development and design of drug utilization programs and new clinical program opportunities
• Facilitate special projects as assigned
• Develop drug information, training and support to all internal and external customers
• Provide analysis and resolution for issues from MAPS,  Health and Medical Management, IT & Ops,  PBM account support team and other customer service areas
• Develop strategies for effective communication of program initiatives in partnership with Clinical Pharmacy for  internal and external customers
• Identify opportunities for workflow efficiencies and new clinical quality and cost saving programs

EDUCATION AND EXPERIENCE REQUIREMENTS:

• Minimum of professional Registered Pharmacist degree required.  Graduate study in a business, public health, or health policy field will be favorably considered.
• Unrestricted current and valid license to practice pharmacy in the state of Massachusetts and/or in any other relevant/applicable state
• Experience in direct supervision of technical support staff for clinical and/or service and operational programs is desirable.
• Experience in a managed care setting, either from the provider, the payer, or the PBM side of the industry, is required.
• Proficiency in standard computational office-suite applications, including word-processing and relational database manipulation is required.

SKILL AND BEHAVIORAL COMPETENCIES REQUIRED:

• Excellent written and oral communication skills
• Excellent interpersonal skills
• Strong organizational and time management skills, including ability to work independently and prioritize multiple projects and assignments
• Demonstrated strength in analysis, identification of problems and issue resolution
• Excellent skills in teamwork and team approaches to goal setting and attainment
• Must be results oriented.

Minimum Education Requirements:

High school degree or equivalent required unless otherwise noted above

Location

Time Type

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting.  We may ultimately pay more or less than the posted range, and the range may be modified in the future.  An employee’s pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note:  No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that the confidence gap and imposter syndrome can  prevent  amazing candidates coming our way, so please don’t hesitate to apply. We’d love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It’s in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting our Company Culture page. If this sounds like something you’d like to be a part of, we’d love to hear from you. You can also join our Talent Community to stay “in the know” on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.