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Job Description

We're seeking a Senior Clinical Pharmacist to join the Pharmacy Professional Engagement and Quality team! In this dynamic role, you will conduct targeted provider outreach to optimize drug therapies and identify cost-savings opportunities for both the plan and members. In addition, the incumbent will utilize integrated data analytics to prioritize outreach opportunities, document interventions on a web-based platform, and calculate plan savings for reporting. Collaborate via telephonic and fax communication with providers, pharmacies, and members to achieve enhanced health outcomes and reduce overall drug expenditure. Engage in continuous monitoring and follow-up to assess the financial impact of successful interventions. Partner with additional clinical pharmacists to provide insights and feedback to improve processes and enhance overall efficiency.

•What You Will Do

+ Perform high-touch provider outreach to recommend optimization of drug therapies and cost-saving measures for the Commercial line of business.

+ Utilize an integrated data analytics application that identifies non-optimized drug use and cost-saving opportunities.

+ Leverage current clinical guidelines and evidence-based research to support recommended interventions, adhering to any Trade, Legal, or Compliance considerations.

+ Evaluate rule logic categories to prioritize workload and make timely interventions.

+ Conduct phone outreach with providers, pharmacies, and members to communicate recommendations and ensure end-to-end execution of the opportunities.

+ Document all interventions in a web-based platform for tracking and reporting.

+ Calculate Commercial plan savings upon successful intervention for validation, tracking, and reporting. Presents progress and savings quarterly to Corporate Pharmacy and other leadership teams.

+ Ensure clinical compliance with law and regulatory bodies, including the Centers for Medicare and Medicaid Services (CMS).

+ Collaborate with PBM and internal teams to identify new clinical pharmacy strategies which result in high-quality, cost-effective pharmacy management and outcomes.

+ Manage and support academic detailing programs.

+ Pursue active membership in professional organizations and seek continual professional development to identify industry trends, best practices, and innovative solutions to current and emerging industry challenges.

What You Bring

+ Bachelor's degree or advanced degree

+ 5+ years of experience in related field

+ In lieu of degree, 7+ years of experience in related field

+ Licensed pharmacist or eligible for licensure in North Carolina.

Bonus Points (preferred qualifications)

+ Ideal candidates must possess excellent oral and written inter-personal communication skills, time management, and critical thinking skills

+ Candidates with managed care experience and academic detailing experience will be preferred

+ Sales experience supporting ASO population, understanding of ASO market strongly preferred

What You’ll Get

+ The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community

+ Work-life balance, flexibility, and the autonomy to do great work

+ Medical, dental, and vision coverage along with numerous health and wellness programs

+ Parental leave and support plus adoption and surrogacy assistance

+ Career development programs and tuition reimbursement for continued education

+ 401k match including an annual company contribution

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

_*Based on annual corporate goal achievement and individual performance._

$100,500.00 - $182,700.00

Skills

Clinical Knowledge, Clinical Pharmacy, Clinical Practice Management, Clinical Programs, Clinical Review, Clinical Trials Operations, Medicare, Medicare Part D, Medication Therapy Management, Nursing Practice, Patient Care Coordination, Pharmaceutical Medical Affairs, Pharmacy, Pharmacy Compliance, Pharmacy Management, Pharmacy Operations

About Us

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.

Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all.

Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

We use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview (https://www.e-verify.gov/employees/e-verify-overview) for English or Visión General de E-Verify (https://www.e-verify.gov/es/empleados/vision-general-de-e-verify) for Español.

Request Accommodations

Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please notify HR at [email protected] .

For most roles, you can choose where to work - fully remote in one of the states listed below, in the office, or a hybrid of the two:

Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming