CareFirst Careers

Clinical Pharmacist Manager (DC Medicaid)

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Resp & Qualifications

PURPOSE: Develops, implements, and evaluates clinical pharmacy programs focused on non-mental health disease states including but not limited to diabetes, hypertension, asthma, COPD, HIV for enrollees, providers, and the Medical Management Team.  Maintains a clinical pharmacy program to impact enrollees at risk for non-mental health drug-related problems.  Collaborates with the mental health pharmacist when necessary. Educates providers, enrollees and other health care professionals. Makes enrollees and their needs a primary focus of one's actions; develops and sustains productive enrollee relationships. Maintains knowledge of and assures departmental compliance with Carefirst Blue Cross Blue Shield Community Health plan of District of Columbia’s policies and procedures, and applicable regulatory requirements and accreditation standards.  

PRINCIPAL ACCOUNTABILITIES:  Under the direction of Clinical Pharmacy and Informatics Manager and the Vice President of Pharmacy, the principle duties and responsibilities include, but are not limited to, the following (specific goals for The Pharmacy Department are determined on an annual basis in accordance with directives from the executive board of CareFirst BlueCross BlueShield):

  • Transitions of Care
    • Pharmacist will provide care transition pharmacy services for all discharging enrollees with a non-mental health admission including but not limited to:
      • Prior authorization decision support for discharge medications
      • Counseling for discharge medications
      • Medication reconciliation
      • Follow up based on Transitions of Care Policy
  • Medication Therapy Management (MTM)
    • Pharmacist will use the PBM MTM platform to identify enrollees in need of MTM
    • Pharmacist will document all MTM encounters on the PBM platform and cross document in Care Connect or other designated case management platform
    • information resources, their professional experience and most current clinical practice guidelines
  • Medication Prior Authorization clinical decision-making including approvals and denials
    • Pharmacist will provide a decision on medication prior authorizations as assigned by the Clinical Pharmacy/Informatics Manager
    • The expectation is 100% of these decisions are provided in 24 hours of receipt
  • Education
    • Pharmacist will precept pharmacy students and managed care residents
    • Pharmacist will provide formal and informal education to the Medical Management team
  • Drug Therapy Consultations and Drug Information Questions
    • Enrollees, Medical management, Wellness Navigation will submit drug information questions to the pharmacist via skype, email, phone or referral queue.  The pharmacist is expected to answer these questions using their clinical knowledge, appropriate peer reviewed journal articles, clinical practice guidelines and available drug references

SUPERVISORY RESPONSIBILITY: 

  • Incumbent has no direct supervisory responsibilities.    
  • Incumbent will be expected to supervise Pharmacy residents when assigned learning experiences covered by their service and will be expected to supervise the pharmacy residents in the absence of the Clinical pharmacy manager and/or the Vice President of Pharmacy
  • Incumbent will be expected to precept pharmacy students from at least one college of pharmacy of their choosing

SCOPE DATA: Incumbent is responsible for ensuring the quality of pharmacy services for the target population.

Minimum Qualifications:

Required

  • Graduation from ACPE accredited school of pharmacy
  • Successful completion of a Post Graduate Year One (PGY1) Managed Care Pharmacy Residency
  • Unrestricted license to practice pharmacy in Washington D.C.
  • Minimum 1-year experience working in the Medicaid line of business
  • Successful completion of a Medication Therapy Management (MTM) certificate program
  • Certified American Lung Association Smoking Cessation Facilitator
  • Strong PC skills including the Microsoft Office Suite and Tableau

 Abilities/Skills

  • Excellent customer service
  • Excellent verbal and written communications including telephone etiquette
  • Excellent time management and prioritization skills, attention to detail, accuracy and quality awareness
  • Excellent organizational skill, ability to multitask and work independently in a fast-paced environment
  • Excellent presentation skills both in-person and virtual
  • Ability to be flexible and adapt to change and promote a positive working environment and teamwork, which may be required while working from home

Preferred

  • Prior experience and an understanding of managed care is highly preferred
  • Unrestricted pharmacy licenses in Maryland or Virginia
  • Experience with case management software platforms 
  • Documented experience with HEDIS measures that are impacted by pharmacy

The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly to Federal health care programs.

 

Department

Department:

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

Closing Date

Please apply before: DNP

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.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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