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Clinical Pharmacist

Employer
Blue Cross Blue Shield of ND
Location
Fargo, North Dakota
Salary
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Job Details

All about us

You likely know us as an insurance company, but that’s just a portion of what we do. Hundreds of thousands of North Dakotans trust us to provide them with personalized service and unmatched access to care. It’s a mission we take seriously.

 

We also work with entities throughout the state to challenge the cost and complexity of health care in North Dakota. This uncompromising goal requires caring, innovative people who are ready and willing to help create a new level of health and well-being in North Dakota and beyond.

 

Work environment

This position has the flexibility to be a remote, hybrid or in-office work arrangement with travel to the office as needed. Being located within driving distance of the Fargo, ND office is ideal. We empower our employees to find a work style that is best for them. Learn more at Life at Blue | BCBSND.

Pay information

Pay Level: 027

FLSA Category: Exempt - Salaried

 

A day in the life

The Clinical Pharmacist serves as a primary resource for prescription drug pricing and review. This position evaluates and recommends reimbursement changes to pharmacy-related fee schedules and coding, monitors drug utilization for appropriate use and works with management on the strategic development and direction of clinical pharmacy programs and pharmacy-related medical policy.

 

Your responsibilities will include:
  • Reviews pharmacy claims holds for appropriate billing, pricing, utilization and medical necessity. Determines appropriate pricing for claims not having a specific code. Determines medical appropriateness by ensuring that a drug was used in accordance with Food and Drug Administration (FDA) labeling or a recognized indication.
  • Consults with reimbursement staff on drug pricing issues and fee schedules.
  • Develops and recommends appropriate reimbursement levels for codes, infusion claims, chemotherapy drugs, high dollar major medical claims and compounds.
  • Serves as a key member on pharmacy committee(s) coordinating meetings, disseminating meeting materials and maintaining minutes. Ensures committee decisions are implemented, partners with the pharmacy benefit manager vendor to ensure claim system edits are implemented and updates and posts critical benefit documents. Participates in internal committee(s) presenting new and updated pharmacy related medical polices.
  • Develops medical policy for new-to-market medications and updates existing pharmacy-related medical policy.
  • Serves as an internal consultant/subject matter expert on pharmacy benefit issues and pharmaceutical technical questions.

 

What you need to succeed
  • Master's degree in Pharmacy
  • 3 years of retail, clinic, hospital pharmacy or related.
  • North Dakota registered pharmacist.
  • Advanced knowledge in the pharmacy field.
  • Ability to communicate and present to others as this will be an important aspect of this role.
  • Attention to the details and ability to think analytically.
  • Strong decision-making skills. 

 

Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards

 

Benefits and perks
  • Wellness incentives including well-being lifestyle spending accounts, employee assistance program and employee discounts.
  • Encouraged paid time off including paid holidays and flexible holidays to use as you wish.
  • 16 hours of paid volunteer time with a $200 donation to a charity of your choice upon completion of all volunteer hours.
  • Employee recognition, community initiative events and yearly company outings.
  • Workplace flexibility offering different options for working arrangements and the freedom to make time for important commitments.
  • Our core benefits include health, dental, vision and life insurance, short-term and long-term disability and paid parental leave.

 

Job posting policy

Employees new to Blue Cross Blue Shield of North Dakota are eligible to apply for positions within their assigned department after successfully completing 90-days in their role. For positions outside of their department, new employees should attain a minimum of six months of service before applying for a new role. Exceptions to this are acceptable, provided there is good business justification for making the move.

 

Equal opportunity employment

Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.

For questions, please email careers@bcbsnd.com.

This job posting will be closed 2/1/2023 at 8:00 a.m. (CT). No further applications will be considered.

Company

TWO WORDS – MEMBERS FIRST.

That sums up why we’re here. And according to member satisfaction surveys, 95.6% say we’ve done a great job at maintaining that focus.

With that said, there are still mountains to move. America’s health care system needs an overhaul and Blue Cross Blue Shield of North Dakota is taking a lead role. To accomplish that, we need BOLD people who believe they can make an impact.

Are you ready to shake up an industry?

If you’re passionate about taking on our nation’s number one health care concern, there may be a place for you on one of our teams.

Company info
Website
Location
4510 13th Ave. S.
Fargo
ND
58103
United States

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