Your Role
The Pharmacist, Consultant (Quality Assurance Pharmacist) is responsible for the design, development, maintenance, and delivery of audit programs for the Prior Authorization/Drug Utilization program. Reporting to the Sr. Manager, Medication Policy, Pharmacy Services, this role facilitates new hire and ongoing audits and serves as a role-model and change agent.Your Work
In this role, you will:
Conduct and maintain audit records to support compliance with all regulatory and accreditation requirements
Coordinate with pharmacy leaders to identify new training needs for existing employees
Identify issues, develop, and implement an appropriate action plan that focuses on performance improvement goals
Provide support for quality audit programs with external vendors
Report and provide timely feedback of audit results to management
Provide subject matter expertise to fellow team members performing drug utilization review to ensure high quality reviews using evidence-based clinical decision making with emphasis on being member-centric
Collaborate cross-functionally with onboarding and training of new DUR team members for all lines of business
Provide external reports for DMHC, NCQA, CMS, and DHCS
Your Knowledge and Experience
Requires a Doctor of Pharmacy (PharmD) degree
Requires an active California Registered Pharmacist (RPh) license
Requires 2 years of experience in clinical pharmacy, with at least 1 year of experience in Drug Utilization Review or equivalent program within a Managed Care environment preferred
Excellent documentation and organization skills is preferred
Excellent verbal and written communication skills is preferred
Proficiency with AuthAccel and Microsoft Office applications is preferred
Knowledge of prior authorization regulatory requirements is preferred
Experience with training technology systems, platforms, and tools are preferred
Pay Range:
The pay range for this role is: $ 118800.00 to $ 178200.00 for California.
Note:
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
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