Pharmacist, Consultant

At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We're excited to share Blue Shield of California has received awards and recognition for - LGBT diversity, quality improvement, most influential women in corporate America, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we're striving to make a positive change across our industry and the communities we live in - Join us!

Description

Job Summary

This position is primarily responsible for supporting the Blue Shield of California Pharmacy and Therapeutics (P&T) Committee process, and supports the clinical components of the Pharmacy Services Benefit Management Drug Authorization Program by ensuring that evidence based clinical decisions of the Blue Shield of California Pharmacy and Therapeutics Committee are implemented operationally in order to support safe, efficacious, and cost-effective prescribing of medications provided under the medical benefit.

Responsibilities
  • Support the operational and clinical implementation of medication policies for drugs provided under the medical benefit, for both Commercial, Medicare, and Medi-Cal lines of business.
  • Provide pharmacist support for the drug prior authorization program by providing clinical expertise to Prior Authorization technician team to ensure review of prior authorization requests within all regulatory required time frames.
  • Provide pharmacist support by providing clinical and operational expertise to ensure review of post claims requests within all regulatory required time frames.
  • Ensure compliance with various regulatory and quality accreditation requirements around drug utilization management in order to support safe, efficacious, and cost-effective prescribing.
  • Provide pharmacotherapy expertise for the pharmacy program by supporting the Pharmacy and Therapeutics Committee, drug formulary, prior authorization, drug utilization review and physician reporting programs.
  • Serves as an educational resource to internal and external constituents regarding the Blue Shield drug formulary, medication policies and appropriate drug use.




Qualifications

Knowledge and Experience
  • Pharm. D. degree in Pharmacy and two years experience in clinical pharmacy, or equivalent combination of education and experience, plus current and unrestricted California Pharmacy License. Prior experience in a managed care/PBM setting is preferable.
  • Thorough clinical knowledge regarding therapeutic use of drugs.
  • Excellent oral and written communication skills.
  • Proficient with computers and related software applications.
  • Must be able to work at least one weekend per month and company holidays to ensure team regulatory compliance with prior authorization turnaround times. Hours for this position will include working at least one weekend per month.




Physical Requirements

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
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External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.EEO Policy