Note: The job is a remote job and is open to candidates in USA. CareFirst BlueCross BlueShield is seeking a Clinical Pharmacist to be part of their Quality/Stars Pharmacy outreach team. The role involves improving Medicare Advantage Star Ratings by enhancing pharmacy quality measures and conducting targeted outreach to members, providers, and pharmacies to improve medication-related outcomes.
Responsibilities
- Conduct outbound and inbound outreach to members to address medication adherence barriers and optimize therapy. Engage provider and pharmacies to resolve medication-related issues, including refills, reversed medications, therapy gaps, and clinical interventions. Educate members on medication use, adherence strategies, and disease state management
- Independently manage a daily work queue of prioritized outreach opportunities, ensure timely and effective completion of outreach, documentation, and follow-up activities. Demonstrate strong outcomes by consistently closing gaps and driving measurable results
- Provide clinical guidance and mentorship to pharmacy technicians supporting outreach, partner with cross-functional teams to optimize program performance
- Perform comprehensive medication and clinical reviews to identify opportunities for optimization, safety, and adherence. Support resolution of clinical and administrative barriers, including prior authorizations, formulary alternatives, medication access issues
- Identify and resolve social risk barriers impacting medication adherence, i.e. transportation challenges, cost of affordability concerns and access to care
- Continuously adapts outreach approach and clinical strategy based on real-time data and performance trends
Skills
- Ph.D: Pharmacy (Doctorate of Pharmacy)
- 5 years experience in clinical pharmacy, preferably in a managed care environment
- PHARMD - Licensed Pharmacist Direct Patient Care - Active Registered Pharmacist in Maryland and/or DC
- Self-starter with strong initiatives and ability to operate with minimal direction
- Results-driven mindset with a focus on achieving measurable quality outcomes
- Ability to prioritize work and manage a high-volume, dynamic workload
- Excellent communication skills for engaging members and providers and having sometimes difficult conversations
- Ability to work independently, as well as a member of a team
- A strong balance between clinical expertise and business acumen
- Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence
- Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging
- Must be eligible to work in the U.S. without Sponsorship
- Experience in Medicare and/or Medicaid
- Experience working in healthcare industry with a thorough understanding of prescription benefit management programs and practices
Benefits
- CareFirst offers a comprehensive benefits package
- Various incentive programs/plans
- 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements)
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