Ready to help us transform healthcare? Bring your true colors to blue. The Pharmacy Operations Clinical Pharmacist Manager manages and directs clinical staff in the day to day clinical operational UM activities to ensure that all Commercial (Pharmacy and Medical benefits) and Medicare Advantage Part D coverage determination requests are processed consistently, timely and accurately in accordance with UM guidelines and are compliant with NCQA and CMS guidelines. In this role, you will manage a clinical staff in a call center environment , forecast and manage staffing needs, develop and monitor team and individual metrics, create and utilize reports to measure cost, quality and productivity, identify/ implement workflows and process improvements.This role is eligible for our Flex persona.Your Day to Day:
Partner with Clinical Pharmacy and PBM Clinical teams to assist with strategic planning, development, and implementation of new Clinical Pharmacy and Drug Utilization initiatives to ensure quality, affordable care.
Collaborate daily with the Operations Managers on contact center activities. This includes but is not limited to the successful implementation and operationalization of new UM programs, including education and training non-clinical and clinical staff
Work closely with Clinical Pharmacy and PBM Clinical teams to assist with strategic planning, development, and implementation of new Clinical Pharmacy and Drug Utilization initiatives to ensure quality, affordable care and positive consumer experience
Provide clinical leadership to resolve pharmacy related issues and inquiries regarding UM programs and pharmacy benefits to various internal and external business partners.
Manage the development, implementation and maintenance of departmental workflows and policy and procedures in conjunction with the Operations Managers to ensure regulatory compliance with CMS Chapter 18, and NCQA guidelines
Provide clinical support to internal partners including but not limited to Member Service, Medicare Operations, Compliance, Legal, Medical Directors, Sales/Marketing/Product and external vendors/customers (e.g. PBM) to assist in the development, communication and implementation of Commercial and Medicare Part D formulary and clinical program offerings.
Contribute to a culture of service excellence by anticipating the needs of our providers and members and ensure the Pharmacy Operations team delivers a level of service consistent with the BCBSMA First Call Resolution goals
Develop and support team goals and objectives, work with pharmacists to establish measurable individual performance goals and monitor progress toward achievement of goals on regular basis to ensure high standards are met, recognize success and coach to improve performance issues.
What You Bring:
Minimum of professional Registered Pharmacist degree required. Graduate study in a business, public health, or health policy field will be favorably considered.
Unrestricted current and valid license to practice pharmacy in the state of Massachusetts and/or in any other relevant/applicable state
2-5 years prior pharmacy management experience preferred
Experience in direct supervision of technical support staff for clinical and/or service and operational programs is desirable.
Knowledge of NCQA and CMS Regulatory guidelines is desirable
Experience in a managed care setting, either from the provider, the payer, or the PBM side of the industry, is required.
Proficiency in standard computational office-suite applications, including word-processing and relational database manipulation is required.
We're Looking for:
Excellent written and oral communication skills
Excellent interpersonal skills to establish and maintain positive relationships across the organization
Strong organizational and time management skills in a dynamic environment
Ability to work independently and prioritize multiple projects
Drive projects and goals from planning to execution
Demonstrated strength in analysis, identification of problems and issue resolution
Ability to effectively manage, motivate, coach and mentor clinical staff.
Strong commitment to team development and long-term goal setting
This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties.#LI-HybridMinimum Education Requirements:High school degree or equivalent required unless otherwise noted above LocationHinghamTime TypeFull timeSalary Range: $129,510.00 - $158,290.00The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.This job is also eligible for variable pay.We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.WHY Blue Cross Blue Shield of MA?We understand that the confidence gap (https://www.theatlantic.com/magazine/archive/2014/05/the-confidence-gap/359815/) and imposter syndrome (https://www.braintreepayments.com/blog/overcoming-imposter-syndrome/) can prevent amazing candidates coming our way, so please don’t hesitate to apply. We’d love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It’s in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting our Company Culture (https://careers.bluecrossma.org/us/en/culturepage) page. If this sounds like something you’d like to be a part of, we’d love to hear from you. You can also join our Talent Community (https://careers.bluecrossma.org/us/en/jointalentcommunity?applyType=JTC) to stay “in the know” on all things Blue.At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work (https://careers.bluecrossma.org/us/en/how-we-work) " Page.Voted as the highest in member satisfaction among Massachusetts commercial health plans by JD Power , Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We have been a market leader for over 75 years, and are consistently ranked among the nation's best health plans. Our daily efforts are dedicated to effectively serving our 2.8 million members, and consistently offering security, stability, and peace of mind to both our members and associates.Our Commitment to YouWe are committed to investing in your development and providing the necessary resources to enable your success. We are dedicated to creating a refreshing and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path. We take pride in our diverse, community-centric, wellness-focused culture and believe every member of our team deserves to enjoy a positive work-life balance.Blue Cross Blue Shield of Massachusetts is an Equal Employment / Affirmative Action Employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or expression, or any other characteristics protected by law.Blue Cross Blue Shield of Massachusetts will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with Blue Cross Blue Shield of Massachusetts's legal duty to furnish information.
