Remote

Senior Clinical Pharmacist

Blue Cross and Blue Shield of North Carolina
parental leave, paid time off, tuition reimbursement, 401(k)
United States, Texas
Jun 13, 2025
Job Description The Senior Clinical Pharmacist plans, coordinates and manages the clinical delivery of pharmaceutical benefits and services to Blue Cross NC subscribers. In this role, you will work collaboratively with Medical Directors in the implementation of pharmacy programs. Responsible for the implementation and management of clinical programs including drug utilization review, academic detailing, formulary compliance, generic substitution, clinical case management and physician report cards. Travel Requirements: Approximately 2 visits per year to our Durham, NC campus for onsite meetings. What You'll Do Develops and implements clinical pharmacy strategies which result in high-quality, cost-effective pharmacy management and outcomes. Analyzes, documents, and reports pharmacy project performance results relative to clinical indicators throughout the Plan. Develops and maintains formulary compliance programs. Develops, implements and manages managed care programs such as prior authorization and quantity limitations programs to meet Plan goals. Monitors pipeline for new drugs, works cross functionally to proactively develop management strategies and consults with actuary teams as needed for financial impact of new drugs. Provides estimated savings for new programs and tracks program performance for actualized medical expense savings Reviews specialty drug list on monthly basis for maintenance Acts as clinical subject matter expert for other specialty pharmacy programs such as specialty networks, oncology pathway vendors, etc. Ensures clinical compliance with law and regulatory bodies and represents pharmacy programs before review bodies such as the North Carolina Department of Insurance and the National Committee for Quality Assurance. Pursues active membership in professional organizations and seeks continual professional development in an effort to identify industry trends and best practices and innovative solutions to current and emerging industry challenges. What You Bring Bachelor's degree or advanced degree 5+ years of experience in related field In lieu of degree, 7+ years of experience in related field Licensed pharmacist or eligible for licensure in North Carolina. Bonus Points Background in Managed Care Previous experience creating and implementing prior authorization policies Knowledge of RxClaim What You'll Get The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community Work-life balance, flexibility, and the autonomy to do great work Medical, dental, and vision coverage along with numerous health and wellness programs Parental leave and support plus adoption and surrogacy assistance Career development programs and tuition reimbursement for continued education 401k match including an annual company contribution Learn more Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs.Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. Based on annual corporate goal achievement and individual performance. $100,500.00 - $182,700.00 Skills Clinical Knowledge, Clinical Pharmacy, Clinical Practice Management, Clinical Programs, Clinical Review, Clinical Trials Operations, Medicare, Medicare Part D, Medication Therapy Management, Nursing Practice, Patient Care Coordination, Pharmaceutical Medical Affairs, Pharmacy, Pharmacy Compliance, Pharmacy Management, Pharmacy Operations