Clinical Pharmacist-Care Management

With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.

Detroit, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Award-winning diversity practices<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />Learn more about your options as an external candidate. <a href="" target="_blank" rel="noopener noreferrer">Click here</a> to view open positions.

keywords: medical,education,analysis,support,teamwork,analysis,compliance,values,communication,experience,license,degree,skills,knowledge


Competitive Total Compensation Package

Overview: Responsible for promoting appropriate and/or efficient utilization review of prescription drug claims among BCBSM participating physicians. This position is also responsible for the education of physicians and influencing of prescribing patterns to reduce BCBSM&rsquo;s drug benefit payout and improve the quality of the benefits as it relates to our members. The incumbent serves as the liaison to the Medical Policy department assisting with the development of medical policy as it applies to drugs.
Responsibilities: <ul><li>Participate in clinical coverage review of medication requests, including detection of medication fraud, waste and abuse.</li><li>Develop, implement and update Drug Utilization Review/Evaluation Programs.</li><li>Provide effective and efficient communication of pharmacotherapy issues.</li><li>Develop and implement a variety of behavior modification principles to influence physicians to prescribe appropriately.</li><li>Identify target physicians, establish credibility and utilize both verbal and written communications to modify behavior.</li><li>Serve as the key clinical support person for researching prescription drug inquiries.</li><li>Develop, implement and continually update physician and patient educational materials.</li><li>Support Drug Formulary development, management and publishing of written and web-based Drug Lists and other pharmacy materials and support the BCBSM/BCN P and T Committee.</li><li>Serve as liaison to medical Policy assisting with the development of medical policy as it applies to drugs.</li><li>Participate in clinical and operational process improvement and cost savings opportunities. Support review and resolution of clinical and compliance grievances and appeals.</li><li>Support clinical initiatives related to NCQA, HEDIS, QRS, CAHPS and STAR measures. Adhere to Pharmacy Policies and Procedures. </li></ul>
Requirements: <ul><li>Bachelor's Degree or Doctorate in Pharmacy required. </li><li>The Clinical Pharmacist must have at least three (3) years of experience consulting with physicians on pharmaceutical issues or completion of an accredited American Society of Health-System Pharmacists (ASHP) or Academy of Managed Care Pharmacy (AMCP) or Managed Care Pharmacy or Pharmacy Practice Residency. </li><li>Current unrestricted Michigan pharmacy license. </li><li>Experience as a Clinical Pharmacist is required for the Clinical Pharmacist job classification. </li><li>Drug Information Specialist with proven background and skills will also be considered. </li><li>Must have superior oral and written communication skills and expertise in the design of presentations. The incumbent must have the ability to obtain and devise relevant data and information from existing MIS Systems. </li><li>An understanding or knowledge of drug claims processing systems and/or medical information systems is preferred. </li><li>Other related skills and/or abilities may be required to perform this job. All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability </li></ul>