Director, Clinical Pharmacy

Job ResponsibilitiesLead, direct, and oversee all clinical aspects of current and future pharmacy benefit programs, ensuring appropriate policies, procedures and resources are in place and aligned with all applicable regulations and requirementsDirects and manages staff responsible for the development and implementation of new and revised clinical pharmacy services across pharmacy and medical management; ensures strategic alignment of clinical services across the enterprise where appropriateDirects and oversees all aspects of staff and any vendor(s) performing case review for the pharmacy care management programs, member appeals, grievances and complaints all within the established time periodsLeads the management of appropriate drug utilization through formulary creation, clinical criteria development, and utilization management activities, including prior authorization and appealsJob QualificationsEducationDoctor of Pharmacy (PharmD) DegreeExperience7 years - Senior leadership-level experience and documented record of success in management of multi-disciplinary pharmacy operations requiredSkills\CertificationsCompetency in compendia navigation and researchOutstanding negotiation, presentation, and facilitation skillsExcellent oral and written communication skillsAdaptive to high pace and changing environmentProven effective supervisory and leadership traits to manage and direct othersKnowledge of medical and pharmacy productsBasic understanding of provider reimbursement methodologies, including fee schedule pricing, DRG reimbursement, bundled outpatient hospital payment mechanisms, capitation, risk sharing arrangements and other payment methodologiesDemonstrated consumer healthcare market understanding/knowledge requiredLicenseLicensed in Tennessee to practice Pharmacy, or eligible for licensure in the state of Tennessee to practice PharmacyNumber of Openings Available1Worker Type:EmployeeCompany:BCBST BlueCross BlueShield of Tennessee, Inc.Applying for this job indicates your acknowledgement and understanding of the following statements:BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin,citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:BCBST's EEO Policies/NoticesBlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means. Originally posted on Himalayas