Be part of a vision for a healthier Mississippi as a Clinical Pharmacist.
Our Clinical Pharmacist focuses on best practice patient care and medication optimization rather than routine dispensing or administration. Join our team and start a meaningful career where your work supports better health outcomes for Mississippians every day.
At Blue Cross & Blue Shield of Mississippi, we are seeking Clinical Pharmacists to work in collaboration with the Chief Medical Director to review Prescription Drug Prior Authorization Requests and Appeals for coverage and medical necessity determinations. This Pharmacist also reviews drug database information and drug utilization activity to ensure proper pharmacy benefits administration and makes recommendations for benefit design based on data and trends.
There are currently two positions available.
What You’ll Do:
- Conduct clinical reviews of Prescription Drug Prior Authorization Requests and Prescription Drug Appeals against Prescription Drug Benefits, Medical Policy Guidelines, prescribing information and compendia.
- Research and gather necessary information to complete comprehensive reviews.
- Make objective determinations and recommendations based on information, knowledge and experience.
- Consult with Physician Reviewer to make final determinations.
- Communicate decisions to Prescribing Provider, Specialty Pharmacy and Member as appropriate.
- Meet quality and production rates to maintain established timelines.
Job-Specific Requirements:
- Doctor of Pharmacy (PharmD) degree. Residency is preferred.
- Current Mississippi Pharmacist license (or intent to get same).
- One year or more experience in a fast-paced general retail pharmacy setting.
- Clinical pharmacy knowledge.
- Understanding basic economic principles and the ability to apply them to the utilization management setting.
- Intermediate proficiency using Microsoft Office, specifically Word and Excel.
- Advanced organizational and multitasking skills with the ability to prioritize competing tasks and perform them with accuracy simultaneously.
- Skilled in using clinical terminology to communicate effectively across interdisciplinary teams, including physicians, nursing staff, and administrative personnel.
- Skilled in detailing analytical processes in written form and clearly articulating the rationale behind complex determinations.
- Ability to work at a high degree of accuracy with information that is confidential in nature.
Preferred include:
- Previously managed care or pharmacy benefits management experience.
Why Join Us
- Purpose-Driven Work: Make a meaningful impact on the Health & Wellness of our Members.
- Healthy Culture: Work in an environment with a focus on your health which allows you to thrive. The walking track, onsite gym and café are just a few of the highlights of the campus.
- Compensation & Benefits: We offer a highly competitive compensation package that includes medical benefits, 401(k), ample paid time off and a schedule that supports true work/life balance
How to Apply and the Process:
- Set up a Workday account and complete your application process.
- Attach a copy of a resume and cover letter.
- Check your email for updates.
- Processes may include phone screen, testing, in-person interview (s), background and drug testing.
At Blue Cross & Blue Shield of Mississippi, we’re not just about providing health insurance, we are creating a strong, supportive community which encourages every Mississippian to live their healthiest life. This mission requires a talented and motivated team with diverse sets of skills and experiences, aligned with the commitment of a healthy Mississippi. By combining strong financial stewardship with a focus on the Health & Wellness of Mississippians, we invest in programs, partnerships, and innovations which drive quality care, lower costs, and healthier lives.
Blue Cross & Blue Shield of Mississippi is an Equal opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
It’s good to be Blue!
Blue Cross & Blue Shield of Mississippi is an Equal opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
We offer a comprehensive benefits package that is worth approximately one-third of the salary compensation. Our benefits program is among the best in the health care field. We are looking for employees who can bring their experience, expertise and dedication to work for our customers.
Skills Required
- Doctor of Pharmacy (PharmD) degree
- Current Mississippi pharmacist license or intent to obtain one
- At least one year of experience in a fast-paced general retail pharmacy setting
- Clinical pharmacy knowledge
- Understanding of basic economic principles and their application to utilization management
- Intermediate proficiency with Microsoft Office, especially Word and Excel
- Advanced organizational and multitasking skills
- Ability to use clinical terminology effectively with interdisciplinary teams
- Ability to document analytical processes and explain complex determinations
- Ability to accurately handle confidential information
- Pharmacy residency
- Managed care or pharmacy benefits management experience
What We Do
At Blue Cross & Blue Shield of Mississippi, we work daily to help Mississippians find their personal answers to this question through health and wellness partnerships with quality healthcare providers, employer groups and community leaders across the state. Our goal is to help each person along their journey to a healthier life… their Blue Wellness Journey. Our health and wellness benefits are designed to support our members in understanding their health and in receiving the care they need at the right time and place, beginning with establishing a healthy relationship with a Primary Care Network Provider through an annual wellness visit at no out-of-pocket cost. We partner with our Network Providers to ensure the highest quality, evidence-based care is provided in each care setting from primary care to specialty care through our Primary Care Home, Blue Distinction+ Centers of Excellence and Maternity Care Quality initiatives. We partner with employer groups to make every workplace a healthy workplace by providing tools and information to help employees take ownership of their health and understand and make the most of their benefits, all while working to manage health and healthcare costs. We partner with community leaders and organizations to make healthy living resources available to all Mississippians through the work of the Blue Cross & Blue Shield of Mississippi Foundation, our support of the arts and culture and our Team Blue volunteers. These partnerships and our dedicated team of employees are making a difference every day, in our communities and in the lives of each person we reach. So, what does it mean to be healthy? The answer is about you, your health, your life… and all its possibilities. Live healthy. Live Blue.
