Your Role
The Prior Authorization (PA) team utilizes clinical knowledge to review authorization requests for coverage under the outpatient pharmacy benefit. The Pharmacist, Consultant willwork 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 is a short term position expected to last 1 year from hire*
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