Your Role The Prior Authorization (PA) team utilizes clinical knowledge to review authorization requests for coverage under the outpatient pharmacy benefit. The Pharmacist, Consultant will work as part of the pharmacy benefit Prior Authorization (PA) team to support the Blue Shield of California (BSC) Pharmacy and Therapeutics Committee (P&T) by ensuring that evidence based clinical decisions are implemented appropriately to provide a high-quality and cost-effective pharmacy benefit. The Pharmacist, Consultant (Drug Utilization Review Pharmacist) will report to the Drug Utilization Review (DUR) Pharmacist Manager. Your Work In this role, you will: Support the clinical and operational implementation of P&T approved policies for the pharmacy benefit, for both the Commercial and Medicare lines of business Apply clinical expertise to PA reviews and work collaboratively with the PA and Call Center Teams to support access to safe, efficacious, and medically necessary medications Operate in compliance with all regulatory and accreditation requirements to ensure all requests are reviewed within regulatory required timeframes Serve as a resource to internal and external constituents regarding the Blue Shield drug formulary, medication policies and appropriate drug use Embrace BSC values by answering clinical and operational questions, participating in group discussions, and supporting other team members while working towards a collective goal Use clear and concise communications and on-brand messaging when communicating with providers or members Follow all corporate policies and procedures Operate in compliance with all regulatory and accreditation requirements, and corporate policies and procedures regarding the support access to safe, efficacious, and medically necessary medications Assist in preparing materials for audits and reports; complete projects as assigned Your Knowledge and Experience Requires a Doctor of Pharmacy (PharmD) degree Requires a currently active and unrestricted California Registered Pharmacist (RPh) license Requires at least 2 years of experience in clinical pharmacy Excellent oral and written communication skills Thorough knowledge of therapeutic use of medications
...quality of care with integrity and compassion and are seeking Certified Nursing Assistants (CNAs) or Home Health Aides (HHAs) that share our same... ...preferred. Licensure/Certification: Current, valid Florida CNA license OR 40-75 hour Home Health Aide Certificate Current...
...steps,# Complete this Training and Experience Evaluation # Submit anonline... ...entire shift or departmental unit of the Sterile Processing and Distribution Department. The 2392... ...Senior Sterile Processing and Distribution Technician functions as a first-line supervisor....
...opening experts, not simply a construction material supplier. Our family owned and operated company is currently seeking a Assistant Project Manager to join our team! The Project Management Team is the backbone of our growing business. This position is scheduled...
**Job Description**This program is for registered CT Techs, PET/CT Techs, MRI Techs, and Breast Sonography Techs seeking full time employment at the Mount Sinai Health System.A successful hire could result in a bonus total of $10,000 over the span of 2 years.*_*In order...
...If youre looking to grow in the world of fine furniture handling, art handling, and logistics and you have a passion for it, then we just may have the perfect role for you! We are seeking talented and driven Restorers to join our organization. The ideal candidate will...