The Pharmacist Consultant, Medicare Quality is responsible for functions related to the application of evidence-based medication prescribing and use strategies that enhance Blue Shield of California member and population health outcomes while optimizing healthcare resources, ensuring that members have access to pharmaceuticals they need, and that the medications they take are improving health.
Performs clinical pharmacist activities associated with Blue Shield of California's Medicare opioid safety program (Drug Management Program), such as conducting medication reviews with members and communicating clinical recommendations to providers.
Work collaboratively with a cross-functional team of clinicians, pharmacy technicians, and customer service representatives to ensure Medicare member medication-related inquiries or pharmacy-related care gaps are resolved.
Oral and written communication with members and providers to ensure medication and quality care gaps are closed, and to ensure safe and appropriate use of medications.
Provides clinical oversight for pharmacy technicians and other staff regarding quality improvement activities.
Provide pharmacotherapy expertise for Blue Shield's pharmacy program by supporting: Pharmacy and Therapeutics Committee, drug formulary, drug prior authorization and utilization review programs, health plan benefit design, member/provider communications related to medication use, and the pharmacy student/residency programs.
Operate in compliance with all regulatory and accreditation requirements, and corporate policies and procedures regarding to support access to safe, efficacious, and medically necessary medications.
Act as a functional area lead to other team members.
Assist in preparing materials for audits and reports; completes projects as assigned.
Other duties as needed.
Knowledge & Experience
PharmD degree and 2 years of experience in a clinical pharmacy practice setting or managed care setting, or equivalent.
Completion of PGY1 or PGY2 pharmacy residency preferred.
Currently active and unrestricted California Registered Pharmacist (RPh) license.
Thorough clinical knowledge regarding therapeutic use of drugs.
Excellent oral and written communication skills.
Intermediate to advanced level skill and experience with MS Office applications (Word, Excel, Power Point).
Strong project or program management skills.
Strong work ethic, upbeat personality with a can-do attitude.
About Company: At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We're excited to share Blue Shield of California has received awards and recognition for - LGBT diversity, quality improvement, most influential women in corporate America, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we're striving to make a positive change across our industry and the communities we live in - Join us!
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