FEP Clinical Pharmacist- Hyrbid

FEP Clinical Pharmacist

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona (AZ Blue) aims to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services. We are committed to helping individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy called Workability, offering flexibility with how and where employees work. Positions are classified as hybrid, onsite or remote. Our hybrid roles require residency within the State of Arizona, with onsite requirements varying by position.

Purpose of the Job

Provide utilization and drug interaction reviews for FEP member benefits and coverage criteria. Perform member-specific interventions through provider collaboration and comprehensive medication reviews, focusing on cost savings, HEDIS measure gap closure, and reduction of readmissions.

Qualifications

Required Qualifications

• 3+ years as a practicing pharmacist
• 3+ years of experience in managed care pharmacy
• Doctor of Pharmacy (Pharm.D) degree
• Active, unrestricted Arizona pharmacist license
• Specialty certification in Medication Therapy Management (obtain within 6 months of hire)

Preferred Qualifications

• 5+ years as a practicing pharmacist
• 5+ years of experience in managed care pharmacy
• 2 years of experience with Medicare Part D formulary and utilization management
• 2 years of experience in Medication Therapy Management

Essential Job Functions and Responsibilities

• Collaborate with FEP Management, Operations, and HEDIS to communicate medication therapy recommendations to FEP members and providers.
• Partner with FEPDO and Pharmacy Management teams, and collaborate with other plan pharmacy representatives.
• Act as a clinical resource to FEP internal staff regarding medication therapy.
• Evaluate medication-related problems such as adverse events, therapeutic duplication, adherence, polypharmacy, and untreated conditions.
• Analyze, document, and report member outreach and intervention performance results per the FEP MTM Program.
• Educate and train on appropriate medication use and monitor patient response.
• Document all interventions via a medication-related action plan or care plan.
• Support and resolve pharmacy-related member benefit issues.
• Utilize prescription and medical claim data for clinical recommendations according to MTM and Retrospective Drug Utilization Review protocols.
• Provide clinical recommendations on gaps in care, high-risk medications, adherence, drug interactions, and substitutions.
• Use client formulary and member benefits to guide medication recommendations.
• Stay updated on clinical trends, diseases, literature, and medication therapies for specific patient populations.
• Participate in cross-functional team meetings to improve clinical programs and processes.
• Maintain effective working relationships to ensure teamwork in achieving corporate goals.
• Participate in quality initiatives, including audits, reporting, and corrective actions.
• Coordinate activities between multiple divisions to achieve desired results.
• This is a full-time position (40+ hours per week).
• Travel may be required.

Competencies

Required Job Skills

• Proficient in critical literature evaluation and evidence-based medicine principles.
• Excellent problem-solving skills.
• Strong written and verbal communication.
• Strong PC proficiency.
• Intermediate skill with office equipment.
• Strong skills in word processing, spreadsheet, and database software.

Required Professional Competencies

• Flexible skills in a changing operational environment, with a drive for results.
• Strong customer service skills.
• Interpersonal skills for harmonious relationships with providers, members, and coworkers.
• Ability to recognize strategic opportunities and make sound decisions using data.
• Flexibility and willingness to adjust to shifting demands/priorities.

Required Leadership Experience and Competencies

• High standard of performance while pursuing aggressive goals.
• Ability to lead by example.

Key skills/competency

• Clinical Pharmacy
• Utilization Review
• Drug Interaction
• Prior Authorization
• Medication Therapy Management (MTM)
• Managed Care Pharmacy
• HEDIS Measures
• Provider Collaboration
• Formulary Management
• Retrospective Drug Utilization Review