Job Description

Pay Range:

$116,900.00 - $187,100.00

Please email HR_Talent_AcquisitionTeam@bcbsri.org if you are a candidate seeking a reasonable accommodation for the application and/or interview process.

At BCBSRI, our greatest resource is our people.

We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do—not just for our members, but for our employees as well.

We recognize that to do your best work, you have to be your best self.
It’s why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees.

Our culture is one of belonging.
We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you’re at in the organization, you’re an integral part of our team and your input, thoughts, and ideas are valued.

Join others who value a workplace for all.
We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders.

We’re dedicated to serving Rhode Islanders.
Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state—building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer.

Why this job matters

Act as an expert on Medicare/Medicaid clinical pharmacy issues as part of an interdisciplinary care team. Provide support to pharmacy program management and case management to assist in the development and maintenance of high quality, cost-effective pharmacy programs and care plans. 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 issues.

What you will do:

• Act as an expert on Medicare/Medicaid clinical pharmacy issues within the organization and to external companies including the company Pharmacy Benefit Manager. Respond to clinical questions regarding prescription medications including those utilized by members.
• Collaborate with internal departments and physicians to develop care plans to facilitate high quality outcomes (i.e. drug adherence, appropriate drug utilization, reduced hospital admissions) with a goal of driving quality, cost-effective care.
• Ensure that medications and other pharmaceutical services are prescribed and dispensed according to plan pharmacy benefit designs/policies, professional standards, and state/ federal requirements.
• Assist in the development and maintenance of cost-effective pharmacy programs. Provide insight to pharmacy management services related to disease management initiatives.
• Review prescriptions issued by physician or other authorized prescriber to ensure appropriateness of therapy and compliance with the formulary.
• Assist in the development of physician educational interventions.
• Analyze prescription data to identify areas of improved quality, and provide recommendations to providers
• Educate internal departments on plan policies, benefits, and any other administrative matters related to pharmacy.
• Perform other duties as assigned.

What you need to succeed:

• A combination of education and related work experience.
• Current and unrestricted Pharmacist license in the state of Rhode Island
• Three to five years clinical pharmacy experience.
• 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
• Strong and effective decision-making skills
• Excellent verbal and written communication skills, with ability to convey complex or technical information in an effective manner.
• Proficiency with Microsoft Suite of products (i.e. Excel, Word, PowerPoint, etc.)

The extras:

• D-SNP Pharmacy management experience
• Managed care experience and specific knowledge and training in prescription drugs, pharmacy benefits, utilization review, cost containment strategies, and emerging technology.

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
  

Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today’s healthcare industry. BCBSRI is an equal opportunity employer.

The law requires an employer to post notices describing the Federal laws. Please visit   www.eeoc.gov/know-your-rights-workplace-discrimination-illegal to view the "Know Your Rights" poster.