SUMMARY: The purpose of the Medicare Part D PGY1 residency program is to empower and educate the resident in all areas of Medicare Part D practice, including but not limited to: * Formulary Management (including Rebates) * Pharmacy and Regulatory Compliance and Audit * Pharmacy Benefits Management * Clinical Pharmacy Programs * Plan Performance and Quality Assurance * Medicare Part B and D Prior Authorizations and Appeals * Product Development * Administration and Leadership RESPONSIBILITIES/TASKS: * Assist Senior Leadership in the planning, development, and implementation of Medicare Part D products, programs, and services such as submission of the CMS bid. * Help to develop, implement and maintain utilization management and drug utilization review programs. * Serve as a key clinical support person for processing drug information inquiries. * Participate in the Pharmacy & Therapeutics committee, making both clinical and financial formulary recommendations. * Develop, implement and continually update physician and patient educational materials. * Work with various internal departments to develop sound clinical programs as well as monitor and report effectiveness and overall cost savings related to these programs. * Promotion of appropriate prescribing behavior among BCBSM participating physicians for the Medicare Part D population. * Propose, plan, execute, and review quality assurance activities related to medication reconciliation, academic detailing and controlled substance clinical reviews. * Assist with oversight of the Part D Medication Therapy Management program, including vendor management and MTM program submission to CMS. * Prepare, review and conduct presentations and/or continuing education programs to various audiences, including providers and internal pharmacy and medical staff. * Assist with internal and CMS audits, and other Part D operational areas, such as transition monitoring and 1/1 readiness. * Participate in the review of prior authorizations for drugs covered under Medicare Part D and Part B. * Participation in the development and execution of initiatives to improve the Medicare Stars quality measures, especially focusing on medication adherence programs. * Completion of a pharmacy research project, including a poster presentation. * Collaborate with the formulary team to help with the drug rebate program, formulary development and the Coverage Determinations, Appeals and Grievance process. * Assist with the Part D component of Requests for Proposals from prospective client groups. * Identify opportunities for improvement in clinical programs based on data analysis. * Aid in the management of high-cost specialty medications. * Actively participate in the education of pharmacy students, both as a lecturer at the Wayne State University College of Pharmacy, and by precepting pharmacy interns and students on rotation. EMPLOYMENT QUALIFICATIONS: EDUCATION: * Doctor of Pharmacy degree required. * PharmD program GPA of at least 3.0 is highly preferred. * Possess current Michigan Pharmacist License within 90 days of start of position. EXPERIENCE: (Minimum experience necessary to perform this position) Managed care pharmacy work or internship experience is strongly preferred. * Thorough knowledge and practical application of the principles of evidence-based medicine. * Must be proficient in Microsoft Office (Word, Excel and PowerPoint). * Must be experienced and confident in communicating with other health care professionals. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: * Must have superior oral and written communication skills and expertise in the design of presentations. * Excellent customer service skills. * Ability to manage multiple tasks. * Demonstrated leadership skills and ability to work well both in teams and independently. * Ability to problem-solve and consensus-build. * Strong commitment to accuracy, especially in the communication of clinical information. * Detail-oriented with excellent organizational and time-management skills. WORKING CONDITIONS: Work is performed in an office setting with no unusual hazards. PAY RANGE: Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $46,100 and $77,200. The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description. We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an \"at will\" basis. Nothing herein is intended to create a contract.
