Your Role The Prior Authorization (PA) team utilizes clinical knowledge to review authorization requests for coverage under the outpatient pharmacy benefit. The Pharmacist, Consultant will work as part of the pharmacy benefit Prior Authorization (PA) team to support the Blue Shield of California (BSC) Pharmacy and Therapeutics Committee (P&T) by ensuring that evidence based clinical decisions are implemented appropriately to provide a high-quality and cost-effective pharmacy benefit. The Pharmacist, Consultant (Drug Utilization Review Pharmacist) will report to the Drug Utilization Review (DUR) Pharmacist Manager. Your Work In this role, you will: Support the clinical and operational implementation of P&T approved policies for the pharmacy benefit, for both the Commercial and Medicare lines of business Apply clinical expertise to PA reviews and work collaboratively with the PA and Call Center Teams to support access to safe, efficacious, and medically necessary medications Operate in compliance with all regulatory and accreditation requirements to ensure all requests are reviewed within regulatory required timeframes Serve as a resource to internal and external constituents regarding the Blue Shield drug formulary, medication policies and appropriate drug use Embrace BSC values by answering clinical and operational questions, participating in group discussions, and supporting other team members while working towards a collective goal Use clear and concise communications and on-brand messaging when communicating with providers or members Follow all corporate policies and procedures Operate in compliance with all regulatory and accreditation requirements, and corporate policies and procedures regarding the support access to safe, efficacious, and medically necessary medications Assist in preparing materials for audits and reports; complete projects as assigned Your Knowledge and Experience Requires a Doctor of Pharmacy (PharmD) degree Requires a currently active and unrestricted California Registered Pharmacist (RPh) license Requires at least 2 years of experience in clinical pharmacy Excellent oral and written communication skills Thorough knowledge of therapeutic use of medications
...Boll & Branch, the leading designer and retailer of luxury home textiles that are managed from the source, is seeking a talented and driven... ...knowledge of textiles, techniques, color and technical skill sets Requirements: ~ Candidates must submit a portfolio demonstrating...
...Patrique Mercier Recruitment is seeking a Freelance Recruiter to join our dynamic team! This is a fantastic opportunity to work from home and manage your own schedule while helping connect talented candidates with exciting job opportunities. As a Freelance Recruiter,...
...life balance? Follow your heart to Virginia Heart! At Virginia Heart, we are looking for a professional Cardiac Technician Exercise Physiologist with critical thinking skills that can work quickly and efficiently while providing excellent patient care. This is...
**Description**Overview:The Regional Inside Sale Associate (RISA) will retain and grow existing customers within the Vestis Direct... ...years of successful inside sales business to business experience- Travel Requirements:- Education:A Bachelor's Degree is preferred but...
...A career at Whole Foods Market is more than just the work you do- it's about your personal growth... ...to customers and Team Members at all times. All positions must be performed in accordance... ...skills and willingness to work as part of a team. Ability to deliver information...