Pharmacist

Schedule: Hybrid Compensation: $109,000 - $181,600 Jump into the new world of health insurance:   At Blue Cross & Blue Shield of Rhode Island (BCBSRI), our business is healthcare. But our focus is on improving lives. Be part of a team that is large enough to make a difference but small enough to be innovative. Work in a rapidly changing field. Take a chance to be creative. Move outside the status quo. Shape new ideas with the power of a national brand behind you.  Join others who know diversity is strength:   We appreciate and celebrate everything that makes us unique: age, national origin, citizenship status, perspectives, experiences, physical or mental disability, military status, race, ethnicity, religion, gender, sexual orientation, gender identity and/or expression. Our diversity strengthens us as an organization and helps us better serve an increasingly diverse Rhode Island population.  Why this job matters: Act as an expert on clinical pharmacy issues.  Provide support to pharmacy program management and assist in the development and maintenance of cost-effective pharmacy programs.  Respond to internal questions concerning plan coverage and policies for specific pharmaceuticals, research appropriateness of drug therapies, and provide feedback on state regulatory and legislative issue.    What you will do: Function as the subject matter expert on the interdisciplinary care team on medications, guideline directed medical care, and clinical pharmacy subject matter such as appropriateness of drug therapies, and sate and regulatory issues related to medications.  Follow the DSNP Model of Care CMS guidelines for promoting plan quality, plan performance, coordination of care and care management. Assess the status of the patient’s health problems or conditions and determine whether the prescribed medications are optimally meeting the patient’s needs and goals of care by evaluating the appropriateness and effectiveness of the patient’s medications, recognizing untreated health conditions that could be improved or resolved with appropriate medication therapy, following the patient’s progress to determine the effects of the patient’s medications on health conditions and/or goals of care and consulting with the patient’s physicians and other health care providers in selecting the medication therapy that best meets the patient’s needs and contributes effectively to the overall therapy. Support and collaborate with the interdisciplinary care team members and providers by responding to clinical and pharmacy benefit questions regarding medications and providing education regarding medication and chronic condition management to develop and achieve care plan goals. Develop medication related action plans to ensure high-quality cost-effective guideline directed care. Review trend analytics to provide insight into medical and pharmacy utilization trends. Work successfully to achieve optimal plan performance ratings in accordance with Medicare Part D. Attend daily huddles and other required company and care management team meetings. Perform other duties as assigned.   What you need to succeed: Bachelor’s degree in related field Valid Pharmacist license in the state of Rhode Three to five years’ experience in managed care Pharmacy management experience Specific knowledge and training in prescription drugs, pharmacy benefits, utilization review, cost containment strategies, and emerging technology. Knowledge of formularies, rebate contracts, and pharmacy benefit design Knowledge of cost containment and utilization review strategies Knowledge of state and federal laws as applicable to the health insurance industry Knowledge of health care plans and benefits Analytical skills Strong communication and presentation skills. Interpersonal skills    Extras: Supervisory experience or experience leading a team.   Location: BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role: In-office: onsite 5 days per week Hybrid: onsite 2-4 days per week Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia