Clinical Pharmacist-Medicare Stars Center of Excellence (Job Number:11590)
Description
Summary:
The position provides hands-on support, consultation, technical and subject matter expertise, pharmacy leadership to the Medicare Star Center of Excellence. This will include oversight of pharmacy benefit manager (s) Star activities, ensuring strong clinical programs aligned with organizational direction, compliance with State Government and CMS Part D requirements related to Star, and optimizing the plans medication therapy management program.
Accountabilities:
1. Oversee Star-related clinical pharmacy operations internally at Blue Cross and with external PBM and vendors.
2. Serve as the clinical subject matter expert on clinical pharmacy as it relates to Medicare Star activities and measurement.
3. Oversee PBM clinical Star-related clinical operations and ensure clinical initiatives for regulatory compliance and organizational alignment (i.e. Medication Therapy Management, Drug Adherence Programs).
4. Maintain expert level of knowledge of Medicare Part D regulations by participating in CMS calls and reading released guidance and implementing changes to maintain compliance.
5. Manage contracts, performance and relationships for partnered vendors of clinical Star-related services.
6. Monitor, evaluate, develop and implement quality initiatives related to specific Star Metrics
7. Serve as the clinical pharmacy expert on a variety of Star-related committees and workgroups (i.e. Quality Management, Utilization Management).
8. Partner with product management, marketing, quality, health management and other Enterprise partners to improve/optimize the plans star rating for Part D clinical elements.
9. May have direct reports with responsibilities that would include interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensuring employees receive the proper training. Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations and cost control.
The job description in not intended to be an exhaustive list of all functions and responsibilities of the position. Employees are held accountable for all functions of the job. Job duties and the % of time identified for any function are subject to change at any time.
- Work is performed in an office setting
- In-state and out-of-state travel occasionally required
- Required travel between Eagan campus building locations
Qualifications
Required Qualifications:
- Accepting this director level position at BCBSMN requires signing an Agreement Regarding Non-Disclosure of Confidential Information and Non-Competition as a condition of employment.
- Pharm D required
- Clear and active pharmacist license in the State of MN
- Prior demonstrated success working in pharmacy operations in a retail or clinical setting
- Experience in case evaluation, communication with physicians, and solid clinical background related to drug utilization including review of drug-related problems
- General knowledge of Medicare Part D Stars measures
- Excellent verbal and written communication skills
- Superior analytical, quantitative, and problem-solving skills
- Proficient and confident conducting discussions in front of large and small groups, including executive/managerial audiences and medical professionals—with necessary clarity, tact, and diplomacy
- Able to lead and conduct projects according to milestones of achievement and deadlines
- A highly professional, approachable and engaging communication and work style that engenders trust, credibility and collegiality
Blue Cross Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.
Primary Location: United States-Minnesota-Eagan
Shift: Day Job
Description
Summary:
The position provides hands-on support, consultation, technical and subject matter expertise, pharmacy leadership to the Medicare Star Center of Excellence. This will include oversight of pharmacy benefit manager (s) Star activities, ensuring strong clinical programs aligned with organizational direction, compliance with State Government and CMS Part D requirements related to Star, and optimizing the plans medication therapy management program.
Accountabilities:
1. Oversee Star-related clinical pharmacy operations internally at Blue Cross and with external PBM and vendors.
2. Serve as the clinical subject matter expert on clinical pharmacy as it relates to Medicare Star activities and measurement.
3. Oversee PBM clinical Star-related clinical operations and ensure clinical initiatives for regulatory compliance and organizational alignment (i.e. Medication Therapy Management, Drug Adherence Programs).
4. Maintain expert level of knowledge of Medicare Part D regulations by participating in CMS calls and reading released guidance and implementing changes to maintain compliance.
5. Manage contracts, performance and relationships for partnered vendors of clinical Star-related services.
6. Monitor, evaluate, develop and implement quality initiatives related to specific Star Metrics
7. Serve as the clinical pharmacy expert on a variety of Star-related committees and workgroups (i.e. Quality Management, Utilization Management).
8. Partner with product management, marketing, quality, health management and other Enterprise partners to improve/optimize the plans star rating for Part D clinical elements.
9. May have direct reports with responsibilities that would include interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensuring employees receive the proper training. Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, coaching on performance management and behavior, employee relations and cost control.
The job description in not intended to be an exhaustive list of all functions and responsibilities of the position. Employees are held accountable for all functions of the job. Job duties and the % of time identified for any function are subject to change at any time.
- Work is performed in an office setting
- In-state and out-of-state travel occasionally required
- Required travel between Eagan campus building locations
Qualifications
Required Qualifications:
- Accepting this director level position at BCBSMN requires signing an Agreement Regarding Non-Disclosure of Confidential Information and Non-Competition as a condition of employment.
- Pharm D required
- Clear and active pharmacist license in the State of MN
- Prior demonstrated success working in pharmacy operations in a retail or clinical setting
- Experience in case evaluation, communication with physicians, and solid clinical background related to drug utilization including review of drug-related problems
- General knowledge of Medicare Part D Stars measures
- Excellent verbal and written communication skills
- Superior analytical, quantitative, and problem-solving skills
- Proficient and confident conducting discussions in front of large and small groups, including executive/managerial audiences and medical professionals—with necessary clarity, tact, and diplomacy
- Able to lead and conduct projects according to milestones of achievement and deadlines
- A highly professional, approachable and engaging communication and work style that engenders trust, credibility and collegiality
Blue Cross Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.
Primary Location: United States-Minnesota-Eagan
Shift: Day Job