Intern - Specialty Pharmacy

<p>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.</p>

Detroit, MI

Blue Cross Blue Shield of Michigan (Internships)

Our Mission: We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health. Our Customer Commitment: We aspire to be clear and simple, to help you make the right choices, to offer valuable coverage, and help you get quality health care for you and those you love. Our Commitment to our Social Mission: Increasing access to affordable health care Enhancing the quality of care patients receive Improving the health of Michigan&rsquo;s citizens and communities.&nbsp; <p><br />Our employees are eligible for several great perks:</p> <ul> <li>Comprehensive medical, dental and vision insurance</li> <li>401(k) with company match</li> <li>Annual bonuses</li> <li>Tuition assistance</li> <li>Paid parking</li> </ul>

keywords: teamwork,relationships,medical,management,write,prepare,teamwork,analysis,support,research,medical,teamwork,knowledge


Paid Internship

Overview: <ul> <li>Describe the BCBSM formulary process and the value of the BCBSM utilization management tools on both medical and pharmacy benefits and how they are maintained from both a clinical and operational perspective</li> <li>Describe how both prescription and medical claims are processed and how BCBSM Pharmacy Services work with its claims processor to ensure correct claim processing</li> <li>Participate in the medication coverage review process, including the clinical review and rendering a coverage determination for medication requests (step-therapy, prior authorization, quantity limits override) on both pharmacy and medical benefits</li> <li>Participate in development and updating of utilization management criteria and protocol development for medical specialty drugs</li> <li>Understand relationships between BCBSM/BCN Pharmacy Services and vendors (i.e. Medical Drug PA tool, preferred Specialty Pharmacy, etc.)</li> </ul>
Responsibilities: <ul> <li>Assist in developing clinical rationale for medication use policies and/or utilization management tools for specialty drugs/classes</li> <li>Prepare clinical criteria documents for presentation at the P&amp;T committee meetings</li> <li>Analyze medical claims to identify processing/reimbursement or patterns of utilization to identify need for a prior authorization</li> <li>Develop and deliver presentations on clinical pharmacy topics for the specialty pharmacy team</li> <li>Research drug information questions</li> <li>Update and/or write new protocol language for branch tree logic and medication request forms in the Medical PA tool</li> <li>Update and/or write new denial verbiage that is member friendly</li> </ul>
Requirements: The BCBSM Pharmacy Services Specialty intern will have the opportunity to work on a variety of projects relating to the practice of managed care pharmacy and specialty pharmacy. Projects will include working on day-to-day medical and pharmacy benefit administration issues, medical pharmacy operations, pharmacy communication, utilization management, and vendor management. The Pharmacy Services Specialty intern is able to participate in the development of specialty drug utilization management criteria working on class criteria documents and new drug reviews lending insight into coverage determinations for medication requests (step-therapy, prior authorization, site of care) on the medical benefit.&nbsp; Projects and assignments will allow the intern to apply the skills and knowledge acquired from pharmacy school to a managed care pharmacy practice environment, while enhancing their therapeutic knowledge, communication, and analytical skills.