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Clinical Pharmacist - Specialty Drug Trend Management (Hybrid)

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Baltimore, MD

Employer:  CareFirst BlueCross BlueShield
Category:  Health Care
Management
Job Type:  Full Time

Description

Resp & Qualifications

PURPOSE:
The Clinical Pharmacist Specialty Drug Trend Management will perform comprehensive clinical services with a focus on trend management for specialty drugscovered under the pharmacy and medical benefit. Responsibilities will include but not are limited to: drug trend management, utilization management program development and monitoring, coverage criteria development, clinical drug evaluations, development of drug management tools, and vendor oversight for delegated programs. This position will work in a matrixed environment across the organization.

This position is HYBRID with travel to the MD, DC, VA area on a quarterly basis. Travel may be required more frequently in the future.

ESSENTIAL FUNCTIONS:
  • Develops and executes on strategies to manage pharmacy and medical benefit drug spend with a focus on specialty drugs. Tracks productivity, quality, impact, and overall performance of drug management strategies, clinical pharmacy programs, formularies, and/or utilization management. Identifies areas where program modifications could result in improvements to patient outcomes and reduce costs. Works collaboratively with vendors, PBMs, and internal parties for oversight of programs and performance management.

  • Acts as a specialty drug subject matter expert; provides expertise to both internal and external stakeholders regarding specific pharmacy trends and market insights; provides recommendations to control specialty drug costs across pharmacy and medical benefits.

  • Develops and provides formal written and verbal presentations or other communication materials related to specialty drug management, clinical pharmacy programs, pharmacy utilization, pharmacy strategy, and pharmacy topics to a broad audience including both internal and external stakeholders.

  • Assesses value of specialty drug management strategies, clinical pharmacy programs and strategies through clinical outcomes, usage, quality, and financial metrics to assist in meeting strategic plan goals. Ensures pharmacy programs are compliant with regulatory mandates. Participates in the development and execution of initiatives to improve quality measures.

  • Reviews pharmacy market information and trends to develop and coordinate implementation of appropriate strategies or programs for cost containment and clinical management with a focus on specialty drugs.


QUALIFICATIONS:

Education Level: Ph.D in Pharmacy (Doctorate of Pharmacy).

Experience: 5 years experience in clinical pharmacy, preferably in a managed care environment.

Preferred Qualifications: Experience working in healthcare industry with a thorough understanding of prescription benefit management programs and practices across multiple lines of business (Commercial, Medicare, Medicaid), with a focus on specialty pharmacy. Certified Specialty Pharmacist (CSP) credential preferred.

Knowledge, Skills and Abilities (KSAs)
  • Ability to work independently, as well as a member of a team.
  • Strong critical reasoning skills in clinical decision-making, planning and organizing.
  • Current knowledge of clinical practices and related information systems and computer applications, required.
  • A strong balance between clinical expertise and business acumen.
  • Strong interpersonal, written and verbal communication skills, including presentation skills.

Licenses/Certifications:
PHARMD - Licensed Pharmacist Active in any state and/or DC Registered Pharmacist Upon Hire Required

Salary Range: $111,920 - $200,057

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Pharmacy Management

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.

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