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FEP Clinical Pharmacist

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Blue Cross Blue Shield of Arizona

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Location:
United States , Phoenix

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Category:
IT - Software Development

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Contract Type:
Not provided

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Salary:

Not provided
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Job Description:

Provide utilization and drug interaction of drug therapies to include review of prior authorization requests according to FEP member benefits and coverage criteria. Perform member specific interventions through provider collaboration and comprehensive medication review with a focus on cost savings, HEDIS measure gap closure, and reduction of readmissions.

Job Responsibility:

  • Collaborate with FEP Management, FEP Operations, and FEP HEDIS to create clear communication to FEP members and/or network providers on medication therapy recommendations
  • Work in partnership with FEPDO and Pharmacy Management team
  • Regularly collaborate with other plan pharmacy reps and programs
  • Collaborate with FEP Management and HEDIS staff for targeted FEP ongoing initiatives
  • Act as a clinical resource to FEP internal staff regarding medication therapy
  • Evaluate medication related problems such as adverse events, therapeutic duplication, adherence to therapy, polypharmacy, and untreated disease or conditions
  • Analyzes, documents, and reports member outreach and intervention performance results as required by the FEP Medication Therapy Management Program (MTM Program)
  • Provide education and training on the appropriate use of medications to monitor and evaluate patient’s response to therapy
  • Document all interventions via a medication related action plan or care plan (CP)
  • Support and resolve pharmacy related member specific benefit issues
  • Utilize prescription and medical claim data to generate clinical recommendations according to Medication Therapy Management and Retrospective Drug Utilization Review program and protocols
  • Provide clinical recommendations pertaining to, but not limited to, gaps in care, high risk medications, compliance and adherence, drug interactions, therapeutic substitution, and generic substitution
  • Utilize client formulary information and member specific benefits to guide appropriate medication recommendations
  • Maintain awareness of current and emerging clinical trends including but not limited to specialty practice, diseases, published literature and medication therapies for specific patient populations to educate clinical team, physicians and other prescribers
  • Actively participate with cross functional team meetings to improve clinical programs, enhance processes and share clinical information
  • Maintain effective working relationships to ensure teamwork in achieving corporate goals
  • Participate in quality initiatives
  • including functions that support audits, reporting, evaluation of quality opportunities and concerns, and creation and implementation of corrective actions as requested
  • Coordinate activities between multiple divisions to achieve desired results
  • The position requires a full-time work schedule
  • Travel may be required
  • Perform all other duties as assigned

Requirements:

  • 3 years or more as a practicing pharmacist
  • 3 years or more experience in the managed care pharmacy field
  • Doctor of Pharmacy (Pharm.D) degree
  • Active, current and unrestricted State of Arizona (a state in the United States) pharmacist license
  • Specialty certification in Medication Therapy Management (may obtain certification within 6 months of job entry)
  • Proficient in critical literature evaluation skills, including evidence-based medicine principles
  • Excellent problem-solving skills
  • Strong written and verbal communications
  • Strong PC proficiency
  • Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
  • Strong skill in word processing, spreadsheet and database software
  • Flexible skills in an operationally changing environment, with drive for results based on planned objectives
  • Strong customer service skills
  • Interpersonal skills that allow for harmonious relationships with providers, members and coworkers
  • Recognize strategic opportunities and use data to make timely and sound decisions
  • Flexibility and willingness to adjust to shifting demands/priorities
  • High standard of performance while pursuing aggressive goals
  • Ability to lead by example

Nice to have:

  • 5 years or more as a practicing pharmacist
  • 5 years or more of experience in the managed care pharmacy field
  • 2 years of experience with Medicare Part D formulary and utilization management
  • 2 years of experience in performing Medication Therapy Management
  • 1 year experience with drug therapy
  • 1 year experience with HEDIS or population health
  • 1 year experience in quality improvement

Additional Information:

Job Posted:
May 05, 2026

Employment Type:
Fulltime
Work Type:
Hybrid work
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