Director, Clinical Pharmacy
BlueCross BlueShield of Tennessee
full-time
Posted on:
Location Type: Remote
Location: Tennessee • United States
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Job Level
About the role
- Lead, direct, and oversee all clinical aspects of current and future pharmacy benefit programs, ensuring appropriate policies, procedures and resources are in place and aligned with all applicable regulations and requirements
- Directs and manages staff responsible for the development and implementation of new and revised clinical pharmacy services across pharmacy and medical management; ensures strategic alignment of clinical services across the enterprise where appropriate
- Directs and oversees all aspects of staff and any vendor(s) performing case review for the pharmacy care management programs, member appeals, grievances and complaints all within the established time periods
- Leads the management of appropriate drug utilization through formulary creation, clinical criteria development, and utilization management activities, including prior authorization and appeals
Requirements
- Doctor of Pharmacy (PharmD) Degree
- 7 years - Senior leadership-level experience and documented record of success in management of multi-disciplinary pharmacy operations required
- Competency in compendia navigation and research
- Outstanding negotiation, presentation, and facilitation skills
- Excellent oral and written communication skills
- Adaptive to high pace and changing environment
- Proven effective supervisory and leadership traits to manage and direct others
- Knowledge of medical and pharmacy products
- Basic understanding of provider reimbursement methodologies, including fee schedule pricing, DRG reimbursement, bundled outpatient hospital payment mechanisms, capitation, risk sharing arrangements and other payment methodologies
- Demonstrated consumer healthcare market understanding/knowledge required
- Licensed in Tennessee to practice Pharmacy, or eligible for licensure in the state of Tennessee to practice Pharmacy
Benefits
- Health insurance
- Remote work options
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Doctor of Pharmacy (PharmD)compendia navigationclinical pharmacy servicesdrug utilization managementformulary creationclinical criteria developmentprior authorizationappeals managementprovider reimbursement methodologiesconsumer healthcare market understanding
Soft Skills
negotiationpresentationfacilitationoral communicationwritten communicationadaptabilitysupervisory skillsleadership traits
Certifications
Licensed in Tennessee to practice Pharmacy