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 Health Services 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.
CareFirst has a large enrollment of members. The BlueCross BlueShield Association’s mission is to enable the success of Blue plans like CareFirst to help members get optimal care. Within the Pharmacy department at CareFirst, the Clinical Pharmacist will support a broad range of professional activities and responsibilities including comprehensive medication reviews for the population. This position is responsible for the comprehensive management of member medication regimens and collaborating with nurses, pharmacists, and physicians to integrate services for the best possible care of the member.
Under the general supervision of the Program Director of Comprehensive Medication Review the incumbent’s accountabilities may include, but are not limited to, the following:
1. Delivery of Comprehensive Medication Reviews
• Performing data collection of members to identify referrals for the Comprehensive Medication Review Program.
• Performing telephonic therapeutic consultations to patients and/or prescribers.
• Completing a Pharmacotherapy assessment of patient’s claims, past medical history and disease states.
• Provide clinical recommendations pertaining to, but not limited to, adverse events, therapeutic duplication, adherence to therapy, polypharmacy, high risk medications, therapeutic substitution, and untreated disease or conditions.
• Utilize formulary information and member specific benefits to guide appropriate medication recommendations.
• Developing a plan of care that details actions of the patient and/or prescriber based on the Pharmacotherapy assessment.
• Provide patient education on the appropriate use of medications and monitoring the patient’s response to therapy.
• Documentation of the plan of care into the data base.
• Communication of identified medication recommendations to the patient, prescribers, and other members of the healthcare team.
2. Reporting and Quality Performance
• Track productivity, quality, impact, and overall performance of pharmacy interventions.
• Participation in quality assurance projects related to the Comprehensive Medication Review Program.
• Identify areas where system modifications could result in operational improvements and report those to the Comprehensive Medication Review Program Director.
• Develop, review, and maintain medication and chronic disease state management plans to improve patient outcomes and cost savings to the organization.
• Actively participate in team meetings to improve clinical programs, enhance processes, and share clinical information.
3. Participation in Other Pharmacy Programs as Assigned
• Partners with the Clinical Innovations team to address medication HEDIS measures including but not limited to Asthma, Hypertension, Diabetes, and ADHD.
• Participates in innovative solutions and clinical programs designed to meet pharmacy needs.
• Collaborate with care teams to participate in strategic planning and innovation to meet institutional, regulatory, provider, and patient care needs.
• Provide clinical services that support day-to-day operations and safe practices.
• Current pharmacist licensure in good standing
• Doctorate of Pharmacy degree plus a minimum of 5 years’ experience in clinical pharmacy, preferably in management care environment
• Experience with population health or disease state management
• Self-motivated, with demonstrated ability to work independently with minimal supervision.
• Experience with delivering telehealth services or healthcare call center operations a plus
• Knowledge of best practices for medication therapy management and clinical services.
• Ability to prioritize ongoing and new projects, as well as conduct research and gather information
• Strategic and analytical thinking skills with an ability to solve problems and make decisions
• Oral/written communication, presentation, and interpersonal skills
• Ability to research and analyze the medical literature including drug information, disease states and clinical practice guidelines.
• Current pharmacist license in state of Maryland
• PharmD and residency
• Ability to network within a large organization and on an interdisciplinary team; support effective partnerships with key groups and individuals
• Skill in the development of creation and design of programs for chronic diseases within a complex health care environment
• Ability to establish goals, structures, and processes necessary to implement a patient care program
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: 5.1.21
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 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