Your Role
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.
This position will require working at least two (2) weekends per month (both Saturday and Sunday) and Holidays. Your Work
In this role, you will:
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
Your Knowledge and Experience
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
Excellent oral and written communication skills
Thorough knowledge of therapeutic use of medications
Pay Range:
The pay range for this role is: $118,800.00 to $178,200.00 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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