Clinical Pharmacist Manager, Formulary and Pharmacy & Therapeutics: Blue Shield of California

Helping make health care for Californians easy, accessible and reasonably priced is a great calling. Knowing that your company has channeled over $100 million back into California communities and will continue to do so is flat out uplifting. Join the hardest working, not-for-profit health plan in California and be part of the solution.

The Clinical Pharmacist Manager, Formulary and Pharmacy & Therapeutics will be based in El Segundo, CA and reports directly to the Director of Clinical Pharmacy Programs. This pharmacist manager interfaces and supports the Clinical Manager of Drug Utilization Review, the Medical Director for Pharmacy & Therapeutics, and the external members of the Blue Shield of CA Pharmacy & Therapeutics Committee.

This Clinical Manager is responsible for supporting the Blue Shield of California Pharmacy and Therapeutics (P&T) Committee process, and supports all aspects of formulary and medication coverage policy development and management.

The Pharmacy Benefit Management Department at Blue Shield of California is a part of the HealthCare Services Division. The pharmacy benefit for members is managed internally by Blue Shield of California. Internal pharmacy management services include services such as pharmacy network management, benefit design, Pharmacy and Therapeutics (P&T) Committee, formulary management,

prior-authorization, customer service, drug use review and pharmacy quality improvement.

This manager is specifically responsible for:

• Providing pharmacotherapy expertise in leading the development of evidence-based drug reviews and in leading clinical discussions for P&T Committee consideration. Assessing statistical analyses in published clinical trials for validity and applicability in clinical practice.
• Providing pharmacotherapy expertise in the development of the clinical intent for medication coverage policies for drugs in both the prescription and medical benefits.
• Ensuring compliance with regulatory and quality accreditation requirements for maintenance of a P&T Committee process, formularies, medication coverage policies that support safe, efficacious, and cost-effective prescribing and drug use. Establishing and maintaining related policies and procedures.
• Attending P&T Committee meetings (travel required).
• Monitoring the pharmaceutical pipeline for new and upcoming drug therapies, analyzing their potential impact on treatment recommendations, utilization, and cost of health care trends.
• Providing timely drug information support when needed for medical necessity reviews of urgent or escalated drug utilization management cases.
• Tracking, monitoring and analyzing formulary management reports to regularly assess implementation of formulary and policy decisions.
• Researching and answering questions related to medication coverage questions.
• Coordinating information from pharmaceutical manufacturers related to P&T reviews, ensuring that appropriate experts and other parties are in attendance at Pharma meetings, and documenting such contacts with CV and disclosure of conflict statements.
• Supervising, hiring and training of the Drug Information pharmacist staff; planning, assigning and directing work; establishing and maintaining operational guidelines and procedures for work; appraising performance, rewarding and disciplining of employees; addressing complaints and resolving problems.
• Actively participating in the Pharmacy Benefit Management leadership team activities of the organization.

Required knowledge, skills and experience for this role include the following:

• Doctor of Pharmacy degree (PharmD) and seven years related experience and/or training, or equivalent combination of education and experience.
• Current valid California registered pharmacist licensure (RPH).
• Thorough clinical knowledge regarding therapeutic use of drugs.
• Demonstrated ability to drive to quality decisions with teams, peers and leaders.
• Excellent oral and written communication skills.
• Excellent math, analytical and problem-solving skills.
• Proficient with computers and related software applications, including Microsoft Office.
• Managed care and/or 3+ years of drug information-related experience preferred.

Blue Shield of California is an Equal Opportunity Employer.