Arkansas Blue Cross and Blue Shield

Pharmacist

• Assists in development and supervises the drug utilization and prior authorization review program.
• Develops and implements pharmacy cost containment strategies tailored to the specific situations and patterns of the enterprise, specific regions, and large accounts.
• Drafts pharmaceutical criteria and performs other activities in support of the enterprise prior authorization program.
• Keeps up-to-date on medication information, contributing to the identification of pharmacy program best practices, collaborating with Medical Directors, leadership, and clinical department as a subject matter expert (SME).
• May be responsible for conducting the second level review for medical and pharmacy benefit medication prior-authorizations, exceptions, and medical necessity reviews submitted to the plan.
• May be responsible for ensuring appropriate alignment of medical policies and configuration for claims processing and utilization management.
• Performs other duties as assigned.
• Prepares and presents reports, data and analyses on the utilization and cost trends for enterprise lines of business, specific regions, and large accounts.
• Provides leadership and advice on developing and implementing pharmacy reimbursement, claims processing policies and procedures, and pharmacy vendor selection.
• Reviews and interprets coverage across assigned line(s) of business to determine what type of review is required and works with requesting providers, corporate medical directors, and other internal staff, as appropriate, in determining whether a specific case presentation meets the criteria for approval according to the specific coverage criteria.
• Serves as a liaison to individual pharmacists, professional pharmacy organizations, internal committees, case management, medical management, and other providers on pharmacy issues.
• Supports pharmacy initiatives for member, provider, and client satisfaction.
• Uses clinical knowledge and independent critical thinking skills towards interpreting criteria, policies, and procedures to make determinations on prior approval reviews and retrospective reviews and/or pharmacy consultations within case management.
• Uses knowledge of the pharmacy and/or medical benefit to communicate with, and provide recommendations to Care Management nurses, social workers, and medical directors.
• Uses knowledge of the pharmacy and/or medical benefit to ensure our members receive their medications in a timely fashion, avoiding delays in treatment.

Clinical Pharmacist

Consultant

• Employs advanced analytics to gain critical insights into member behavior drivers and preferences.
• Consults business leaders and internal partners to apply insights to test and drive product innovation and enhancement.
• Measures program outcomes and demonstrates value, helps win and retain clients, and supports information-based strategic decision making.
• Brings together multiple sources of complex data to design and develop reports that answer business questions.
• Collaborates with business stakeholders across the organization to understand analytics needs and deliver plans to meet those needs.

Healthcare Analytics Consultant

Analyst

• Collaborates with internal stakeholders and vendors on system enhancements, upgrades, and new feature adoption.
• Configures and supports Epic Payer Platform applications to enable payer-provider interoperability.
• Develops and maintains documentation, workflows, and training materials for end users.
• Ensures timely and accurate data exchange to support risk adjustment, care gap closure, quality measurement (e.g., HEDIS), and the development of member longitudinal health records.
• Evaluates system performance, monitors data quality and mapping, and identifies opportunities to improve operational efficiency, reduce administrative burden, and enhance provider engagement.
• Identifies and implements process improvements to enhance efficiency and reduce administrative burden.
• Leverages reporting and analytics to monitor performance, identify trends, and support decision-making.
• Monitors and ensures data quality, accuracy, and appropriate mapping across systems.
• Partners with internal stakeholders, vendors, and provider teams to troubleshoot issues, support system enhancements, and drive adoption of Payer Platform capabilities that improve interoperability, streamline processes, and enable more effective, data-driven decision-making to improve member outcomes.
• Partners with providers to onboard, test, and optimize Payer Platform integrations and workflows.
• Troubleshoots application, integration, and workflow issues across payer and provider environments.

Payor Platform Applications Analyst

• Analyzes and resolves issues reported by external and internal users.
• Attends and/or facilitates new group implementation meetings to obtain detailed benefit information.
• Collaborates with Legal to resolve compliance issues.
• Coordinates Plan Document language with the Benefit team for purposes of system configuration and benefit administration.
• Ensures systems configuration leadership is aware of problems and the actions taken to correct problems.
• Develops and maintains Plan Documents, amendments, Summary Plan Descriptions, and Summaries of Benefits and Coverages; ensuring that all documents are signed or approved in a timely manner by the Plan Administrator through direct contact with the Plan Administrator and coordination through the regional offices.
• Maintains electronic storage of Plan Documents and amendments for internal staff and Web-based storage for the clients.
• Performs other duties as assigned.
• Provides support to the Benefit Team and internal team.
• Utilizes an internet-based Plan Document system to create the initial Plan Document template. Creates and maintains libraries for the purposes of custom-tailoring of each document with language specific to the plan administration, benefit plan design, and client practices.

Plan Document Analyst

Software Engineer

• Consults with users to identify current operating procedures and to clarify project objectives.
• Contributes to and supports the Enterprise strategic and operational planning process including total quality management philosophies.
• Designs, testable code and develops test protocols or plans and reviews revisions and results.
• Designs and develops high-volume, low-latency applications for mission-critical systems and delivers high-availability and performance applications.
• Develops and implements processes to ensure accurate and effective workflow distribution.
• Develops applications and creates deliverables aligned with processes and enterprise standards.
• Enhances and applies programming analysis, design, coding, testing, debugging, implementation and documentation.
• Provides technical expertise of subsystems and any other performance related systems.
• Uses standard application design principles to create logical and physical application designs to promote efficiency and code reuse.

Developer

• Serve as the point of contact between IT and end users.
• Responsible for incident resolution by restoring services as quickly as possible or escalation to the appropriate IT resource and incident logging and categorization.
• Responsible for request fulfillment support and knowledge management, providing users with guidance and support for their IT needs.
• Assists in the incorporation, installation, training, support and coordination of new and ongoing projects that involve several teams.

Clinical Pharmacist

Healthcare Analytics Consultant

Payor Platform Applications Analyst

Plan Document Analyst

Developer

IT Service Desk Analyst – Associate