Employer: Blue Cross Blue Shield of Michigan Job Title: Clinical Pharmacist / Pharmacist Job Location: 500 Renaissance Center, Tower 500, Detroit, MI 48243 Job Type: Full-time, 40 hours a week, Monday - Friday Duties: Responsible for promoting appropriate and/or efficient utilization review of prescription drug claims among BCBSM participating physicians. Participate in clinical coverage review of medication requests, including detection of medication fraud, waste and abuse. Develop, implement and update Drug Utilization Review/Evaluation Programs. Provide effective and efficient communication of pharmacotherapy issues. Develop and implement a variety of behavior modification principles to influence physicians to prescribe appropriately. Identify target physicians, establish credibility and utilize both verbal and written communications to modify behavior. Serve as the key clinical support person for researching prescription drug inquiries. Develop, implement and continually update physician and patient educational materials. Support Drug Formulary development, management and publishing of written and web-based Drug Lists and other pharmacy materials and support the BCBSM/BCN P and T Committee. Serve as liaison to medical Policy assisting with the development of medical policy as it applies to drugs. Participate in clinical and operational process improvement and cost savings opportunities. Support review and resolution of clinical and compliance grievances and appeals. Support clinical initiatives related to NCQA, HEDIS, QRS, CAHPS and STAR measures. Adhere to Pharmacy Policies and Procedures. Hybrid remote work permitted within a reasonable distance of the Detroit, Michigan Office. Requirements: Doctorate in Pharmacy and seven (7) years of experience as a Clinical Pharmacist, Drug Information Specialist, Manager, Pharmacy Services, Staff Pharmacist, or related role where experience was gained. Also requires the following: * 7 years of experience in Consulting with physicians on pharmaceutical issues and direct patient care; * Unrestricted Michigan pharmacy license; * Pharmacy leadership experience in managing pharmacists, pharmacy technicians, or other health professionals; * Board certification in pharmacotherapy; and * 3 years of experience in pharmaceutical contract administration and rebate experience. All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability. #VZNP #LI-DNI
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