Your Role

The Pharmacist, Consultant (Quality Assurance Pharmacist) is responsible for the design, development, maintenance, and delivery of audit programs for the Prior Authorization/Drug Utilization program. Reporting to the Sr. Manager, Medication Policy, Pharmacy Services, this role facilitates new hire and ongoing audits and serves as a role-model and change agent.

Your Work

In this role, you will:

• Conduct and maintain audit records to support compliance with all regulatory and accreditation requirements
• Coordinate with pharmacy leaders to identify new training needs for existing employees
• Identify issues, develop, and implement an appropriate action plan that focuses on performance improvement goals
• Provide support for quality audit programs with external vendors
• Report and provide timely feedback of audit results to management
• Provide subject matter expertise to fellow team members performing drug utilization review to ensure high quality reviews using evidence-based clinical decision making with emphasis on being member-centric
• Collaborate cross-functionally with onboarding and training of new DUR team members for all lines of business 
• Provide external reports for DMHC, NCQA, CMS, and DHCS

Your Knowledge and Experience

• Requires a Doctor of Pharmacy (PharmD) degree
• Requires an active California Registered Pharmacist (RPh) license
• Requires 2 years of experience in clinical pharmacy, with at least 1 year of experience in Drug Utilization Review or equivalent program within a Managed Care environment preferred
• Excellent documentation and organization skills is preferred
• Excellent verbal and written communication skills is preferred
• Proficiency with AuthAccel and Microsoft Office applications is preferred
• Knowledge of prior authorization regulatory requirements is preferred
• Experience with training technology systems, platforms, and tools are preferred

Pay Range:

The pay range for this role is: $ 118800.00 to $ 178200.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

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