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Blue Cross and Blue Shield of Louisiana Clinical Pharmacist – Population Management in Baton Rouge, Louisiana

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.

POSITION PURPOSE

This position is responsible for leading the development, implementation, monitoring and maintenance of population-based clinical strategies, clinical programs and/or Medicare strategies and programs. Partners with Patient Centered Medical Home staff and others to develop and track patient pharmacy interventions designed to improve patient health outcomes and cost savings.

NATURE AND SCOPE

  • This role does not manage people

  • This role reports to this job: DIRECTOR, CLINICAL SERVICES, STR & POL

  • Necessary Contacts: To do this job effectively, the incumbent has to be in contact with:All levels of BCBSLA staff including pharmacy Care Management, Care Transformation, Medicare Part D, and Health Informatics teams; and PBM clinical personnel. Communicates and meets with medical directors, physicians and executive staff from patient centered medical homes, accountable care organizations, integrated delivery systems and physician practices.Staff dedicated to Medicare must also be in regular contact with management of the Medicare program including Medicare Operations, Sales & Marketing, Compliance, Financial Investigations, Appeals and Grievances staff and occasionally providers and members.

QUALIFICATIONS

Education

  • Doctorate of Pharmacy required or

  • Bachelors Degree in Pharmacy required

  • Masters training preferred

Work Experience

  • 1 year of experience working in clinical pharmacy roles required

  • Any of these experiences are preferred: • Rounding with physicians and ancillary staff in hospital or primary care settings. • Performance of medication therapy management reviews. • Long-term care consulting experience • Managed care experiencepreferred

  • Medicare Job Specific: Experience working in a government sponsored health care role (e.g. Medicare or Medicaid) preferred

  • Experience with software programs such as Word and Excel is a must and knowledge of database programs such as Access preferred

Skills and Abilities

  • Must have proficiency in pharmacology, therapeutics and knowledge of disease management programs for the purpose of supporting the clinical aspects of this job.

  • Must possess strong interpersonal, organizational, oral/written communication skills in addition to strong clinical skills.

Licenses and Certifications

  • Current pharmacy license in good standing required

  • Participation in ASHP or AMCP-accredited residency program preferred

ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS

  • Leads the development, implementation, education and monitoring of targeted pharmacy or population-based clinical programs or establishing new programs with a primary focus on improving adherence to drug therapies and recommending changes for the purpose of improving patient outcomes, improving Medicare star ratings, and lowering cost.

  • Maintains a through working knowledge of pharmacy benefits (e.g. formulary, outreach programs, utilization management tools and techniques and medical policies) and when needed assists in their development for the purpose of ensuring that the population-based clinical program work hand-in-hand with BCBSLA’s pharmacy and medical benefits.

  • Serves as a pharmacy subject matter expert and drug information resource for clinical staff, providers, program teams, members, BCBSLA operational staff, PBM and/or government agencies (e.g. CMS) for the assigned pharmacy function and/or medication management therapy program.

  • Develops and executes a strategy to identify those patients that are most actionable in terms of medication therapy management and positively influence them and their providers with the goal of improving health outcomes and reducing total cost of care.

  • Staff supporting Medicare also identifies underlying drivers of Part D star performance and develop and implement plans to improve ratings.

  • Works closely with patient centered medical home, case and disease management teams to assist in the development of nursing staff member outreach programs and serve as a resource for complex medication therapy management issues.

  • Helps develop and implement policies, procedures and information systems for tracking changes and successful interventions for the purpose of reporting improved adherence, health outcomes, and cost savings.

  • Accountable for complying with all laws and regulations associated with duties and responsibilities.

Additional Accountabilities and Essential Functions

The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions

  • Job duties are performed in a normal and clean office environment with normal noise levels.

  • Work is predominately done while standing or sitting.

  • The ability to comprehend, document, calculate, visualize, and analyze are required.

#LI_CK1

An Equal Opportunity Employer

All BCBSLA EMPLOYEES please apply through Workday Careers.

PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)

Additional Information

Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.

If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.

Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.

Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.

JOB CATEGORY: Insurance

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