Clinical Program Manager- Pharmacist

Pharmacy Benefit Management (PBM) teams with pharmacies, pharmaceutical manufacturers and physicians to manage the rising costs of prescription drug benefits and costs for our customers.

The Clinical Program Manager (CPM) works collaboratively with the Pharmacy Benefit Management (PBM) company, the Medical Benefit Management company, or other third party vendors to create and support the implementation of clinical programs and drug management strategies under both the pharmacy and medical benefit that will decrease the total cost of care and/or improve the quality of care for our members and employer groups. The CPM will work directly with employer groups and Sales to provide face-to-face clinical consultation and tailored solutions to deliver on value of integrated pharmacy and medical benefits to drive overall healthcare costs down and improve patient outcomes. The CPM may also be involved in the support of initiatives to enhance pharmacy services; streamline processes; reduce administrative costs; improve operational activities; and may be required to ensure support of and compliance with all government-related business and related requirements. Additionally, the CPM maintains knowledge of industry trends to ensure that Blue Cross and Blue Shield of Alabama (BCBSAL) remains market-competitive and market-leading in its drug management programs and offerings. The CPM may also need to maintain a thorough understanding of the Centers for Medicare and Medicaid Services (CMS) or Affordable Care Act (ACA) pharmacy program requirements and guidelines.

The CPM serves as a leader and subject matter expert within the PBM department providing clinical consultative services. The CPM also works collaboratively with internal divisions that are impacted by PBM programs to ensure an integrated approach where all stakeholders are consulted and/or informed about pharmacy related programs and strategies. Examples include, but are not limited to, Provider Networks, Professional Reimbursement, Healthcare Analytics, Sales, Marketing, Product Management, Medical Policy/Review, Health Management, Claims, and Customer Service.

Additional responsibilities include support of member, provider, and employer group communication. For example, the CPM may interact directly with healthcare providers and their staff to establish working relationships, discuss clinical programs, member-specific concerns, or upcoming strategies and opportunities. Additionally, the CPM may interact directly with the member to encourage appropriate drug utilization and management.

The CPM must possess a high level of independent judgment and initiative. The incumbent must autonomously execute tasks that support and fulfill overall business objectives. Having excellent interpersonal skills, a strategic vision, and critical thinking will aid in the successful implementation of new clinical programs and strategies, as well as making decisions in policy exception and interpretation of procedures. The CPM must also interpret a variety of issues and recommend the most effective action to other Pharmacy staff and management succinctly and effectively.

* Bachelor of Pharmacy or Doctor of Pharmacy (PharmD)
* Registered Pharmacist (RPh)
* Active Pharmacist license in good standing in the state of residency; if working in Alabama, must have or be willing to obtain license in Alabama within 1 year of hire
* 2 years of clinical or managed care experience and/or training, or an equivalent combination of education (e.g. pharmacy residency) and clinical or managed care experience
* Experience solving problems and completing assigned projects with minimal supervision
* Proven analytical, interpersonal and effective oral and written communication skills and great attention to detail in order to clarify, simplify and handle multiple complex issues/tasks effectively
* Experience presenting information in formal and informal settings
* Excellent organizational and time management skills
* Doctor of Pharmacy (PharmD) preferred
* Pharmacy Residency preferred
* Knowledge of the pharmacy benefit management (PBM) and managed care industries preferred
* Experience in cross-functional collaboration within an organization, including problem resolution, negotiations, consensus building, conflict management, and decision-making preferred
* Experience leading or spearheading projects and initiatives aimed at streamlining processes, reducing administrative costs, improving operational activities, and/or ensuring compliance with regulatory requirements preferred
* Experience analyzing and synthesizing data to tell a story to both clinical and non-clinical audiences preferred
* 3 years of direct managed care pharmacy experience or 7 years of consulting experience in an outpatient clinic involving specialty medications on both the medical and pharmacy benefit preferred
* Travel requirements may vary dependent upon location; if working in Alabama, willingness to travel up to 10% of the time preferred

The work schedule for this position will be hybrid (onsite/remote). Business areas reserve the right to require associates to return to the office as needed, based on performance or other business considerations. A hybrid work schedule is subject to amendment or termination at any time by the Company.

By submitting a job application, I attest that all information to the best of my knowledge is true and accurate. Furthermore, I understand that any information provided by me throughout the job application process is subject to verification including, but not limited to work experience, education, assessment (test) and interviews.
We appreciate your interest in Blue Cross and Blue Shield of Alabama 'The Company'. The Company does not discriminate in hiring or employment on the basis of race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, genetics, status as a disabled or protected veteran, or because of citizenship status in the case of a citizen or intending citizen. No question on this application is intended to secure information to be used for such discrimination.
Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association