Resp & Qualifications
CareFirst, Inc is a not-for-profit corporation which is the largest health insurer in the mid-Atlantic region with more than 3 million Members, 5,000 associates and more than $8 billion in annual revenue. The company is regarded as a top employer in many surveys and offers competitive salary and benefits. The Clinical Pharmacy Services team is a central department under the Medical Affairs Division that supports the company in delivering high value programs to our employer groups and members. The Clinical Pharmacy Services team is primarily focused on strategic initiatives to improve quality and outcomes and decrease pharmacy costs. The Formulary Clinical Pharmacist will serve as a point person on the Clinical Pharmacy Services team to oversee formulary strategy by assessing drug use trends and new drug releases for the development of appropriate use protocols and guidelines.
The role requires collaboration with several key stakeholders listed below:
- The Pharmacy team within the CareFirst Medical Affairs and Specialty Divisions.
- Core Business Partner, CVS Caremark (Pharmacy Benefits Manager). This partner was chosen based on their overall capacity to support CareFirst members and their respective strength and value in the marketplace.
- A range of internal CareFirst stakeholders including market segment specific Strategic Business Units which support the operational aspects of Pharmacy, and other key units such as Sales and Marketing, Communications, Medical Affairs, Government Mandates, and others.
PRINCIPAL ACCOUNTABILITIES: The position reports directly to the Senior Director of Clinical Pharmacy Services and is a critical position within the unit responsible for understanding the pharmacy marketplace, opportunities for utilization management, and cost containment. The Clinical Formulary Pharmacist will interact frequently with the VP of Clinical Programs, and other senior leaders across CareFirst. The incumbent’s accountabilities include, but are not limited to, the following:
DUTIES AND RESPONSIBILITIES:
Oversee and drive formulary strategy for CareFirst
- Develops and implements clinical pharmacy strategies which result in high-quality, cost-effective pharmacy management and outcomes.
- Examines utilization management, competitor strategies and works with internal/external groups to implement formulary strategies.
- Reviews trends, pharmacy cost of care and coordinates the development of appropriate use protocols and guidelines.
- Continuously monitors evolving pharmacy marketplace and as new drugs come to market analyzes cost impacts and strategies for cost containment or clinical management.
- Review guideline criteria for utilization management.
- Develops and implements clinical pharmacy strategies such as prior authorization and quantity limit programs.
- Contributes to the development of educational materials, newsletters, member and provider talking points about clinical formulary management.
Supports all clinical formulary issues and inquires for internal and external stakeholders
- Provides clinical guidance and support to various departments and address clinical related questions.
- Provides clinical support for the sales teams and attends client meetings.
- Ensures clinical compliance with law and regulatory bodies and serves as a point of contact within the organization for all clinical formulary related internal/external audits.
- Collaborates with the Government/Regulatory teams to assess impact of legislation to clinical pharmacy programs.
Reporting & Value Realization Analysis
- Analyzes and reports value realization of clinical formulary management strategies.
- Assesses value through clinical outcomes, usage, and financial metrics (among others) generated by the program to assist in meeting strategic plan goals.
- Graduate from an accredited School of Pharmacy, PharmD; MBA is preferred.
- Active Maryland Registered Pharmacist.
- 5 years of clinical pharmacy experience in a health plan, hospital, PBM or similar role.
- Experience in Medicare and Medicaid preferred.
- Strong understanding of contemporary clinical, operational, and regulatory pharmacy practices.
- Thorough understanding of prescription benefit management programs and practices, contracting, products/services, cost structures, pricing, and business practices.
- Experience in formulary management.
- Experience with and appreciation for working within the highly regulated healthcare industry.
- Proven record for driving to results through data-driven decision making.
- Thorough knowledge of managed care and pharmacy benefit management practices, including utilization management.
- A strong balance between clinical expertise and business acumen that will ensure the most expedient delivery of pharmaceutical management strategies and solutions.
- Exceptional project management skills and effective at leading in a matrix environment.
- Excellent strategic thinking and planning skills and the ability to develop and implement operational plans.
- Ability to shape Executive Management’s perspective on key Pharmacy programs by synthesizing key business, technical, and data driven points for successful program definition.
- Ability to identify priorities and achieve results with a sense of urgency and give honest straightforward opinions on related issues.
- Proficient at executive level relations and communications both within the company and with business partners, vendors, governmental representatives, and other Health Insurance Industry stakeholders.
- Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
- Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 09/20/2019
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The physical demands described here are representative of those that must be met by an employee to perform the essential duties and responsibilities of the position successfully. Requirements may be modified to accommodate individuals with disabilities.
• Must be able to work in an office setting, primarily seated while performing duties for a minimum of 8 hours per work day.
• Walking and standing is required. Lift weight up to 25 pounds on occasion.
• Hands are regularly used to write, type, key and handle or feel small controls and objects. Must be able to type and to speak on the telephone simultaneously.
• Must have the ability to communicate verbally effectively. Auditory ability is to actively listen.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship