What are the responsibilities and job description for the Clinical Program Manager-Pharmacist position at Blue Cross Blue Shield of Alabama?
Pharmacy Benefit Management (PBM) teams with pharmacies, pharmaceutical manufacturers and physicians to manage the rising costs of prescription drug benefits and costs for our customers.
Primary Responsibilities:
The incumbent will serve as a Pharmacy Engagement Specialist to anchor our new Medicare Advantage Pharmacy Advocacy team designed to engage members and providers on an individual basis. In this role, the incumbent will be instrumental in the development of a new area within the Pharmacy Services Division focused on improving our members' experience, impacting Star measure performance while also realizing pharmacy cost savings.
The incumbent will will serve as a team lead and mentor to a team of dedicated pharmacy specialists. The incumbent must have a heart for our members with excellent and relational communication skills that seeks to educate and impact both members and providers to improve health outcomes and motivate change. They must be able to interpret complex subject matter and simplify adequately to communicate to a broad range of socioeconomic and health literacy levels for understanding.
Core Responsibilities:
The Clinical Program Manager (CPM) works collaboratively with the Pharmacy Benefit Management (PBM) company, the Medical Benefit Management company, or other third party vendors to create and support the implementation of clinical programs and drug management strategies under both the pharmacy and medical benefit that will decrease the total cost of care and/or improve the quality of care for our members and employer groups. The CPM may also be involved in the support of initiatives to enhance pharmacy services; streamline processes; reduce administrative costs; improve operational activities; and may be required to ensure support of and compliance with all government-related business and related requirements. Additionally, the CPM maintains knowledge of industry trends to ensure that Blue Cross and Blue Shield of Alabama (BCBSAL) remains market-competitive and market-leading in its drug management programs and offerings. The CPM may also need to maintain a thorough understanding of the Centers for Medicare and Medicaid Services (CMS) or Affordable Care Act (ACA) pharmacy program requirements and guidelines.
The CPM serves as a leader and subject matter expert within the PBM department providing clinical consultative services. The CPM also works collaboratively with internal divisions that are impacted by PBM programs to ensure an integrated approach where all stakeholders are consulted and/or informed about pharmacy related programs and strategies. Examples include, but are not limited to, Provider Networks, Professional Reimbursement, Healthcare Analytics, Sales, Marketing, Product Management, Medical Policy/Review, Health Management, Claims, and Customer Service.
Additional responsibilities include support of member, provider, and employer group communication. For example, the CPM may interact directly with healthcare providers and their staff to establish working relationships, discuss clinical programs, member-specific concerns, or upcoming strategies and opportunities. The CPM may also deliver presentations and clinical consultation to employer groups regarding the clinical aspects of their drug benefits. Additionally, the CPM may interact directly with the member to encourage appropriate drug utilization and management.
The CPM must possess a high level of independent judgment and initiative. The incumbent must autonomously execute tasks that support and fulfill overall business objectives. Having excellent interpersonal skills, a strategic vision, and critical thinking will aid in the successful implementation of new clinical programs and strategies, as well as making decisions in policy exception and interpretation of procedures. The CPM must also interpret a variety of issues and recommend the most effective action to other Pharmacy staff and management succinctly and effectively.
- Bachelor of Pharmacy
- Registered Pharmacist licensure (RPh)
- Active Pharmacist license in good standing in the state of residency; if working in Alabama, must have or be willing to obtain license in Alabama within 1 year of hire
- 2 years of clinical or managed care experience and/or training, or an equivalent combination of education (e.g. pharmacy residency) and clinical or managed care experience
- Experience solving problems and completing assigned projects with minimal supervision
- Proven analytical, interpersonal and effective oral and written communication skills and great attention to detail in order to clarify, simplify and handle multiple complex issues/tasks effectively
- Experience presenting information in formal and informal settings
- Excellent organizational and time management skills
- In-depth knowledge of the pharmacy benefit management (PBM)/managed care industry, understand drugs as a pharmacy and/or medical benefit, and current clinical pharmacy knowledge preferred
- Have or be willing to develop a thorough understanding of the Centers for Medicare and Medicaid Services (CMS) or Affordable Care Act (ACA) pharmacy program requirements and guidelines preferred
- Experience with formulary and utilization management program development, submissions, and updates for Medicare pharmacy programs preferred
- Experience leading projects in order to streamline processes, reduce administrative costs, improve operational activities, and ensure compliance with all government-related business preferred
- Travel requirements may vary dependent upon location; if working in Alabama, must have the willingness to travel up to 10% of the time preferred
- Doctor of Pharmacy (PharmD) preferred
- Experience with Medicare Part D benefits, traditional pharmacy claims and utilization management processes working in the retail/community pharmacy setting is preferred
- Experience performing Comprehensive Medication Reviews and driving medication adherence improvement is preferred
By submitting a job application, I attest that all information to the best of my knowledge is true and accurate. Furthermore, I understand that any information provided by me throughout the job application process is subject to verification including, but not limited to work experience, education, assessment (test) and interviews.
We appreciate your interest in Blue Cross and Blue Shield of Alabama 'The Company'. The Company does not discriminate in hiring or employment on the basis of race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, genetics, status as a disabled or protected veteran, or because of citizenship status in the case of a citizen or intending citizen. No question on this application is intended to secure information to be used for such discrimination.
Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association
