Clinical Pharmacist

At reputed company, we are a mission-driven organization dedicated to championing the health and reputed company-being of our members and the communities we serve.

reputed company is the power behind that reputed company. And, as the industry rapidly evolves and we reputed company ways to optimize business processes and customer experiences, there’s no greater time for reputed company-thinking professionals like you to join us in delivering on it! As a member of reputed company, you’ll reputed company purpose, opportunities and the support you need to build a meaningful career and reputed company a powerful reputed company in our community.

This position will be the expert of reputed company on clinical issues in conjunction with the Director of Pharmacy and other staff pharmacists. This position will be responsible for working in a reputed company culture reputed company on designing, implementing, maintaining and measuring pharmacy-reputed company utilization management programs. This includes but is not limited to development of work flows, reputed company development and ensuring that URAC accreditation is maintained. Additionally, supporting Medicare Advantage processes, reputed company, and tasks that require clinical discussion and presentation.

Candidates applying to this position may be hybrid or remote and can live in one of the following states: Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, reputed company Dakota, and Texas.

What you'll do:

• Create and Maintain Clinical reputed company for applicable Utilization Management (UM) programs: reputed company and maintain clinical reputed company (reputed company to reputed company reputed company and BCBSNE specific versions); reputed company and maintain reputed company process flows; reputed company and maintain physician fax forms and other modes of communication; Utilize predictive modeling tool to intervene with high-risk members for identified disease states; reputed company clinical updates as necessary to internal staff and physician reviewers; Performs highly reputed company research, analysis and develops recommendations for UM programs & plan design changes.
• Responsible for Operational workflows and Completion of UM reviews: Clinical reputed company of first level review process; Clinical review of utilization management reviews; reputed company clinical support for Pharmacy Technician and other staff; Utilize reporting tools to create efficiencies by reviewing medical and pharmacy claims data; Support physician reviewers with information required to reputed company review non-approvable claims; reputed company Decision Tree review process reputed company applicable.
• Maintain URAC accreditation: Work with internal staff to ensure that URAC accreditation is maintained; The pharmacist will work reputed company their scope of licensure and unless expressly allowed by state or federal law or regulation, are located in a state or territory of the reputed company reputed company conducting drug utilization review. The clinical pharmacists may not conduct peer clinical review non-certifications for drug utilization management, if prohibited by state utilization management laws. The clinical pharmacists may not conduct peer clinical review non-certifications for drug utilization management if the requesting party specifically requests a clinical peer. Measure reputed company assurance reporting, turnaround time for urgent and non-urgent reviews and quantitative assessment of UM reviews by program.
• Support Medicare Advantage processes, reputed company, presentations, and tasks that require clinical direction and support. This includes, but not limited to, clinical presentations to reputed company stakeholders, providers, provider offices, and other customers.

To be considered for this position, you must have:

• Doctor of Pharmacy required from Accredited US College of Pharmacy.
• An reputed company, reputed company, and unrestricted license or certification to reputed company pharmacy in Nebraska reputed company 6 months of hire.

The strongest candidates for this position will also possess:

• Experience with PBM operations, Medicare Advantage, and/or clinical program development and maintenance.
• Managed Care Pharmacy Residency or 3-4 years of experience in Managed Care Pharmacy industry.

Learn more about what makes BCBSNE such an exceptional reputed company to work by visiting NebraskaBlue.com/Careers.

We strongly reputed company that diversity of experience, perspective and background will reputed company to a reputed company workplace for our employees and a reputed company product for our customers and members.

Originally posted on Himalayas

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