Gaps in Care Pharmacist - Capital Blue Cross

Position Description

Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more. 

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”

This position is responsible for the outbound phone calls to members, prescribers, and/or pharmacies to facilitate closure of pharmacy-related HEDIS and Medicare STAR gaps. The incumbent possesses good clinical/analytical skills and sound decision-making capabilities to identify opportunities/risks and propose strategies accordingly. Strong interpersonal and excellent communication skills are essential due to interaction with various members of the medical profession, managed care clients, and members. The incumbent also serves as a resource to providing clinical support to committees and workgroups such as HEDIS/NCQA and Medicare STARS.

Responsibilities and Qualifications

• Clinical evaluation of medication therapy
• Peer to Peer discussions with medical providers to discuss clinical recommendations
• Contributes to program improvements by using continuous quality improvement processes, by being proactive in identifying improvement opportunities and by contributing on-going consultation and collaboration with product leaders
• Collaborates on the refinement of consultation scripting; solicits and utilizes input from those contacted toward scripting improvements
• Upholds clinical integrity of pharmaceutical solutions by staying up to date on medication information, contributing to the identification of pharmacy program best practices, collaborating with Medical Directors and Clinical Pharmacy staff
• Other duties as assigned. Contributes creative solutions to improve operational efficiency and effectiveness of pharmacy team.

Skills:

• Strong interpersonal and team skills with ability to work and interact externally and internally. Ability to communicate effectively with varied audiences, including ability to adapt messages based on the audience (member, prescriber, etc.).  Ability to take direction from various levels of staff and perform project work with minimal supervision. Strong clinical/analytical skills and decision-making capabilities required. Strong interpersonal and excellent communication skills required. Ability to assess utilization data to identity new opportunities.

Knowledge:

• Managed care knowledge and experience preferred. In-depth knowledge and experience with medication therapy management and disease state management. Knowledge of drug formulary systems and drug evaluation process. Broad knowledge of outpatient drug benefit and utilization management programs. Knowledge of pharmacy claims processing along with applicable state/federal laws. Knowledge and experience with Medicare Part D and NCQA accreditation preferred.  People skills are essential that allow for the successful consultation and collaboration with internal and external stakeholders who do not directly report to this position.

Experience:

• Experience in the coordination and collaboration of work teams preferred.  Analytical skills which can translate into practical and pragmatic recommendations. Experience in effective medication counseling, with an emphasis on pharmacy-related STAR measures.

Education and Certifications:

• Pharmacy degree and current Pennsylvania pharmacy license required. Advanced pharmacy degree (Masters or Pharm.D.) preferred.

Location:

• This position is classified hybrid, which requires onsite work on Tuesdays and Wednesdays.

Work Environment:

 

Working environment includes typical office conditions.

 

Physical Demands:

• While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must occasionally lift and/or move up to 5 pounds. Sedentary work involving significant periods of sitting, talking, hearing, keying and performing repetitive motions. Work requires visual acuity to perform close inspection of written and computer-generated documents as well as a PC monitor.

Other:

• Performs other related duties and assignments as directed.
• Occasional overnight travel and travel between CBC locations.

 

About Us

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a diverse and caring team of supportive colleagues, and be encouraged to volunteer in your community.  We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.     And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.