Clinical Pharmacist | PBM

Blue Cross Blue Shield Association
vision insurance, 401(k)
United States, Illinois, Chicago
Jan 15, 2025
The hiring range for this role is: 107,666.00 - 150,995.00 This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range and this hiring range may also be modified in the future. A candidate's position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.This job is also eligible for annual bonus incentive pay. We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees. Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. The role supports the Federal Employees Program Part D/Employer Group Waiver Program pharmacy benefit in all clinical pharmacy functions including but not limited to formulary development, prior approval policy creation and maintenance. Provides support for the medical drug benefit management strategy including market scans and background for Cell and Gene Therapies, along with other medical benefit drugs. This includes creation and maintenance of utilization management criteria, clinical support of manufacturer negotiations and presentations at the Blue Cross Blue Shield Association National Pharmacy and Therapeutics Committee. Functions as the subject matter expert in all aspects of cell and gene therapies, both those on the market as well as those in the pipeline. Develops policies and policy documents for new and existing cell and gene therapy drugs and their accompanying Utilization Management criteria. Meets with manufacturers clinical teams to develop an overall criteria. Presents clinical overviews and new drug evaluations to the National Pharmacy and Therapeutics Committee as well as the Value Assessment Committee. Responsible for reviewing and completing Employer Group Waiver Program Medicare submissions, formulary, Pharmacy and Therapeutics modules, transition supply etc., and review and downloading patient safety and other requires files though the Health Plan Management System portal. Keeps abreast of and interprets trends within the pharmaceutical marketplace and healthcare industry which could affect pricing, delivery system, and benefit coverage and provider utilization and formulates strategies to respond to trends. Provides support to internal pharmacy workgroups and supports manufacturer negotiations from a clinical perspective. Education Pharmacy degree (required) PharmD (required) Certifications Pharmacy license (required) Experience Pharmacy residency or 1-2 years of experience in a Health Plan or Pharmacy Benefit Manager environment. Experience demonstrating an understanding of healthcare delivery, patient care processes, and the interactions among healthcare professionals within the healthcare environment. Experience with drug utilization review and formulary programs Skills Must possess excellent interpersonal skills and the ability to collaborate with all levels of the Association, Plans, government agencies, and vendors. Strong written and oral communication skills are essential. Technical proficiency with information technologies, including Microsoft software applications such as Excel, is required. People Management No #LI-Hybrid