About this role
Blue Cross Blue Shield of Arizona, awarded a Healthiest Employer, fulfills its mission to inspire health and make it easy. AZ Blue offers health insurance products and services for individuals, families, and businesses. It provides tools to help make better health decisions.
This hybrid position requires residency and work within Arizona. It follows a Workability strategy offering flexibility in how and where employees work. Hybrid individual contributors must be onsite at least once per week, with requirements subject to business needs.
Manage the medical drug benefit for Medicaid beneficiaries by implementing operations and maintaining coverage criteria and policies. Assist health plan pharmacists by creating and updating clinical criteria consistent with regulations and evidence-based practice. Review requests for medical drug benefit services.
Improve performance metrics for medical drug authorization processes, including turnaround times and decision integrity. Educate staff on authorization systems, clinical criteria, and case outcomes. Complete projects assigned by Medical Services leadership and collaborate on medication use projects.
Requirements
- 5 years of practice experience with a health plan pharmacy service, managed care environment, and/or retail or hospital pharmacy service
- 2 years of practice experience in developing and applying clinical drug use criteria
- Pharmacy degree from an accredited college of pharmacy
- Active, current and unrestricted State of Arizona pharmacist license
- Experience maintaining clinical criteria consistent with regulatory requirements
- Knowledge of evidence-based clinical practice for drug coverage
- Familiarity with Medicaid plans and medical drug benefits
Responsibilities
- Manage the medical drug benefit for Medicaid beneficiaries
- Implement and manage operations of the medical drug benefit
- Maintain medical drug coverage criteria and policies for diverse Medicaid plans
- Create and update clinical criteria for medical drug coverage
- Review requests for medical drug benefit services
- Improve performance metrics associated with medical drug authorization processes
- Educate staff on medical drug authorization systems and clinical coverage criteria
- Complete projects assigned by Medical Services leadership
Benefits
- Hybrid workforce strategy called Workability for flexibility
- Classified as hybrid with minimum onsite once per week
- Residency within Arizona for hybrid roles
- Opportunity to work with health plan pharmacists on projects
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