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BlueCross BlueShield of Tennessee logo
BlueCross BlueShield of Tennessee

Bringing peace of mind through better health to our customers and communities

Director, Clinical Pharmacy

DirectorDirectorFull TimeRemoteLeadTeam 5,001-10,000Since 1952H1B SponsorCompany SiteLinkedIn

Location

Tennessee

Posted

76 days ago

Salary

0

Seniority

Lead

Professional Certificate7 yrs expEnglish

Job Description

Director, Clinical Pharmacy

BlueCross BlueShield of Tennessee

• Lead, direct, and oversee all clinical aspects of current and future pharmacy benefit programs, ensuring appropriate policies, procedures and resources are in place and aligned with all applicable regulations and requirements • Directs and manages staff responsible for the development and implementation of new and revised clinical pharmacy services across pharmacy and medical management; ensures strategic alignment of clinical services across the enterprise where appropriate • Directs and oversees all aspects of staff and any vendor(s) performing case review for the pharmacy care management programs, member appeals, grievances and complaints all within the established time periods • Leads the management of appropriate drug utilization through formulary creation, clinical criteria development, and utilization management activities, including prior authorization and appeals

Job Requirements

  • Doctor of Pharmacy (PharmD) Degree
  • 7 years - Senior leadership-level experience and documented record of success in management of multi-disciplinary pharmacy operations required
  • Competency in compendia navigation and research
  • Outstanding negotiation, presentation, and facilitation skills
  • Excellent oral and written communication skills
  • Adaptive to high pace and changing environment
  • Proven effective supervisory and leadership traits to manage and direct others
  • Knowledge of medical and pharmacy products
  • Basic understanding of provider reimbursement methodologies, including fee schedule pricing, DRG reimbursement, bundled outpatient hospital payment mechanisms, capitation, risk sharing arrangements and other payment methodologies
  • Demonstrated consumer healthcare market understanding/knowledge required
  • Licensed in Tennessee to practice Pharmacy, or eligible for licensure in the state of Tennessee to practice Pharmacy

Benefits

  • Health insurance
  • Remote work options

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