[Hiring] Clinical Pharmacist @Blue Cross and Blue Shield of North Carolina

Role Description

Provide timely drug therapy for health plan members by reviewing and processing prior authorization requests using clinical judgment and medical policy.

• Review prior authorization requests and make determinations for drug products according to member benefits and coverage criteria
• Report to utilization review statistics to corporate compliance committees
• Review data and summarize daily utilization review numbers
• Responsible for tracking compliance of review cases
• Provide clinical guidance and support to the assigned pharmacy technicians
• Knowledge of drug coding (NDC, GCN, GPI and USC) and NCPDP claims adjudication systems
• Review guideline criteria for prior authorization and non-formulary drugs in support of Pharmacy and Therapeutics Committee function and pharmacy benefit design
• Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practices
• Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews

Qualifications

• Bachelor's degree or advanced degree
• 3+ years of experience in related field
• Current states pharmacy license

Requirements

• Clinical Compliance
• Drug Coding
• Drug Information
• Medical Knowledge
• Medical Policy
• Medical Prescriptions
• Medicare
• Medication Adherence
• Medication Management
• Medication Reconciliation
• Medication Safety
• Medication Therapy Management
• Pharmacy
• Pharmacy Operations
• Pharmacy Regulation

Benefits

• Annual Incentive Bonus (based on annual corporate goal achievement and individual performance)
• 401(k) with employer match
• Paid Time Off (PTO)
• Competitive health benefits and wellness programs

Salary Range

$118,691.00 - $189,906.00

Job Alert Fraud

We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC . If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: [email protected] .