The Clinical Pharmacist - Pharmacy Policy supports the Director-Pharmacy Policy in all clinical functions including but not limited to Prior Approval policy creation and maintenance. Supports the direction for the Federal Employee Program's prescription drug benefit programs and Association initiatives to promote the cost-effective use of pharmaceuticals. Provides support in the development, management and evaluation of the Service Benefit Plan Formulary. Keeps abreast of and interprets guidelines, best practices, and trends within the pharmaceutical marketplace and healthcare industry which could affect pricing, delivery system, and benefit coverage and provider utilization and formulates strategies to respond to trends. Organizational, analytical, and project management skills are also important, as well as the ability to solve problems, make sound business decisions.
Primary Job Functions:
- Develops, manages, and evaluates new and existing drugs utilization management. In addition, provides support oversight over PBM clinical programs. Assists in the assessment and response of member inquiries.
- Assists the Director, Clinical Policy with the management of pharmacy and therapeutics activities including the Pharmacy and Medical Policy Committee (PMPC).
- Supports the Director in the formulation and integration of pharmacy clinical programs with overall FEP Program administrative policy.
- Provides support to pharmacy work groups, best practices, and forums.
- Initiates new programs for managing utilization and increasing cost savings.
Education, Experience, and Certification:
Bachelors Degree - Pharmacy degree is required
PhD - PharmD is preferred
Experience - Required
- Experience that is indicative of the ability to understand how health care and patient care is delivered and how health care professionals interact in the health care environment.
- Experience with drug utilization review and formulary programs.
Experience - Preferred
2 years' pharmacy practice experience including knowledge of how patient care is delivered and how health professionals interact in the health care environment, e.g., accessing specialty drugs, participating in the prior authorization process, communicating formulary alternatives with providers, and understanding pharmacy and therapeutics committee functions.
Certifications
Active pharmacy license in good standing
PGY1 pharmacy residency
Knowledge, Skills, and Abilities
Skills
- Technical proficiency with information technologies (Microsoft software applications e.g. Excel) is required.
- Must have excellent interpersonal skills and the ability to work with all levels of the Association, local Blue Cross and Blue Shield Plans, government agencies (e.g., OPM, CMS) and vendors (e.g., PBMs, consultants).
- Communication skills, written and oral.
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