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Job Description

We’re seeking a Senior Clinical Pharmacist in Medicare Formulary Strategy. In this critical role, you will plan, coordinate and manage the clinical delivery of pharmaceutical benefits and services to Blue Cross NC subscribers. Work collaboratively with Medical Directors in the implementation of pharmacy programs. Responsible for the implementation and management of clinical programs including: drug utilization review, academic detailing, formulary compliance, generic substitution, clinical case management and physician report cards.

What You’ll Do

+ Develop and implement clinical pharmacy strategies which result in high-quality, cost-effective pharmacy management and outcomes.

+ Develop, analyze, report on clinical programs, manage and coordinate between Health Care Management and Health Care Services Development to optimize BCBSNC long-term access to high-quality, cost-efficient pharmacy providers.

+ Analyze, document, and report pharmacy project performance results relative to clinical indicators.

+ Manage and support Academic Detailing programs and conducts site visits as necessary. Participate in education of provider network.

+ Develop, implement and manage managed care programs such as prior authorization and quantity limitations programs in order to meet Plan goals.

+ Ensure clinical compliance with law and regulatory bodies and represent pharmacy programs before review bodies such as the North Carolina Department of Insurance and the National Committee for Quality Assurance. Develop and maintain formulary compliance programs.

+ Develop educational materials, newsletters, member and provider talking points and disseminate clinical information for both internal and external audiences.

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

+ Manage the requirements for the organization’s participation in Medicare Part D.

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

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._

$118,691.00 - $189,906.00

Skills

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