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Principal Pharmacist, Formulary Strategy %26 Management at Blue Shield of CA in Oakland, California

Posted in Other 30+ days ago.

Type: Full Time





Job Description:

Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California is focused on transforming health care by making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 3.5 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution. We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.

The Principal Pharmacist, Formulary Strategy & Management participates in the development and maintenance of multiple formularies to support competitive health plan products, manage cost-of-healthcare, and meet regulatory requirements for all lines of business including Commercial Large Group, Commercial Small Group, Individual/Family plan, Medicare, and Medi-Cal. The Principal Pharmacist will collaborate with cross-functional areas to identify and implement interventions to manage cost of healthcare, meet new regulatory requirements, and develop client-specific solutions through formulary and utilization management optimization.

This is a Short Term Employment Opportunity.

Specific Responsibilities Include:

*

Supports development of formulary strategy for various market products, using clinical studies and guideline information, claims analyses, competitive intelligence, drug pipeline, financial and market data.
*

Monitor and analyze regulatory and legislative requirements, develop project plans to meet requirements and lead cross functional teams to implement programs to meet requirements.
*

Strategize and develop client-specific solutions related to formulary and utilization management and develop project plans to ensure appropriate implementation of program requirements.
*

Subject matter expert on all regulatory requirements related to drug formularies.
*

Provides pharmacotherapy expertise to the team.
*

Evaluates drugs and drug classes and makes formulary positioning and utilization management recommendations.
*

Serve as a BSC Pharmacy Services contact and subject matter expert to stakeholders, and manage external relationships (vendors, clients) related to assigned work.
*

Other projects and duties as assigned.
*

Occasional business travel required. Staff members are located at various Blue Shield of California offices in California.

Knowledge and Skills:

*

Thorough knowledge of managed care and pharmacy benefit management practices, including utilization management.
*

Familiarity with First DataBank and/or Medispan drug files.
*

Prior experience with Medicare Part D, Marketplace, and/or Commercial formulary development and maintenance processes desirable.
*

Strong project or program management skills.
*

Strong independent judgment, critical and analytical thinking, and problem-solving skills required.
*

Strong Pharmacy operational background.
*

Thorough clinical knowledge and credibility regarding therapeutic use of drugs.
*

Excellent interpersonal, written & verbal communication skills
*

Ability to multi-task, prioritize, and deliver in a demanding and constantly changing corporate environment.
*

Advanced level skill and experience with MS Office applications including Access and Excel.

The Principal Pharmacist, Formulary Strategy & Management participates in the development and maintenance of multiple formularies to support competitive health plan products, manage cost-of-healthcare, and meet regulatory requirements for all lines of business including Commercial Large Group, Commercial Small Group, Individual/Family plan, Medicare, and Medi-Cal. The Principal Pharmacist will collaborate with cross-functional areas to identify and implement interventions to manage cost of healthcare, meet new regulatory requirements, and develop client-specific solutions through formulary and utilization management optimization.

This is a Short Term Employment Opportunity.

Specific Responsibilities Include:

*

Supports development of formulary strategy for various market products, using clinical studies and guideline information, claims analyses, competitive intelligence, drug pipeline, financial and market data.
*

Monitor and analyze regulatory and legislative requirements, develop project plans to meet requirements and lead cross functional teams to implement programs to meet requirements.
*

Strategize and develop client-specific solutions related to formulary and utilization management and develop project plans to ensure appropriate implementation of program requirements.
*

Subject matter expert on all regulatory requirements related to drug formularies.
*

Provides pharmacotherapy expertise to the team.
*

Evaluates drugs and drug classes and makes formulary positioning and utilization management recommendations.
*

Serve as a BSC Pharmacy Services contact and subject matter expert to stakeholders, and manage external relationships (vendors, clients) related to assigned work.
*

Other projects and duties as assigned.
*

Occasional business travel required. Staff members are located at various Blue Shield of California offices in California.

Knowledge and Skills:

*

Thorough knowledge of managed care and pharmacy benefit management practices, including utilization management.
*

Familiarity with First DataBank and/or Medispan drug files.
*

Prior experience with Medicare Part D, Marketplace, and/or Commercial formulary development and maintenance processes desirable.
*

Strong project or program management skills.
*

Strong independent judgment, critical and analytical thinking, and problem-solving skills required.
*

Strong Pharmacy operational background.
*

Thorough clinical knowledge and credibility regarding therapeutic use of drugs.
*

Excellent interpersonal, written & verbal communication skills
*

Ability to multi-task, prioritize, and deliver in a demanding and constantly changing corporate environment.
*

Advanced level skill and experience with MS Office applications including Access and Excel.

* PharmD degree and at least 4 or more years of experience in clinical pharmacy and managed care.

* Currently active and unrestricted California Registered Pharmacist (RPh) license.

* Thorough knowledge of therapeutic use of drugs.

* Proven record for driving to results through data-driven decision-making.

* PharmD degree and at least 4 or more years of experience in clinical pharmacy and managed care.

* Currently active and unrestricted California Registered Pharmacist (RPh) license.

* Thorough knowledge of therapeutic use of drugs.

* Proven record for driving to results through data-driven decision-making.

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.