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Clinical Pharmacist or Specialty Pharmacist in Southfield, MI at AF Group

Date Posted: 1/4/2019

Job Snapshot

Job Description

COBX Senior Health Services
Pharmacy Serv Medicare Part D

Responsible for promoting appropriate and/or efficient utilization review of prescription drug claims among BCBSM participating physicians. This position is also responsible for the education of physicians and influencing of prescribing patterns to reduce BCBSM's drug benefit payout and improve the quality of the benefits as it relates to our members. The incumbent serves as the liaison to the Medical Policy department assisting with the development of medical policy as it applies to drugs.


  1. Participate in clinical coverage review of medication requests, including detection of medication fraud, waste and abuse.
  2. Develop, implement and update Drug Utilization Review/Evaluation Programs.
  3. Provide effective and efficient communication of pharmacotherapy issues.
  4. Develop and implement a variety of behavior modification principles to influence physicians to prescribe appropriately.
  5. Identify target physicians, establish credibility and utilize both verbal and written communications to modify behavior.
  6. Serve as the key clinical support person for researching prescription drug inquiries.
  7. Develop, implement and continually update physician and patient educational materials.
  8. Support Drug Formulary development, management and publishing of written and web-based Drug Lists and other pharmacy materials and support the BCBSM/BCN P and T Committee.
  9. Serve as liaison to medical Policy assisting with the development of medical policy as it applies to drugs.
  10. Participate in clinical and operational process improvement and cost savings opportunities.
  11. Support review and resolution of clinical and compliance grievances and appeals.
  12. Support clinical initiatives related to STAR measures.
  13. Adhere to Pharmacy Policies and Procedures.


  1. Bachelor's Degree or Doctorate in Pharmacy required.
  2. The Clinical Pharmacist must have at least three (3) years of experience consulting with physicians on pharmaceutical issues or completion of an accredited American Society of Health-System Pharmacists (ASHP) or Academy of Managed Care Pharmacy (AMCP) or Managed Care Pharmacy or Pharmacy Practice Residency.
  3. Experience in specialty pharmacy, including experience in a leadership role or completion of a BCBSM American Society of Health-System Pharmacists/Academy of Managed Care Pharmacy (AMCP/ASHP) accredited Managed Care Pharmacy residency or completion of another Managed Care Pharmacy Residency program plus 2 years of experience is preferred.
  4. Current unrestricted Michigan pharmacy license.
  5. Experience as a Clinical Pharmacist is required for the Clinical Pharmacist job classification.
  6. Drug Information Specialist with proven background and skills will also be considered.


To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


  1. Must have superior oral and written communication skills and expertise in the design of presentations. The incumbent must have the ability to obtain and devise relevant data and information from existing MIS Systems.
  2. An understanding or knowledge of Medicare rules and regulations as it relates to pharmacy or medical benefit claims adjudication.
  3. An understanding or knowledge of drug claims processing systems and/or medical information systems is preferred.
  4. Other related skills and/or abilities may be required to perform this job.


Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.


Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.


Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.


The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is occasionally required to stand and walk. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, and ability to adjust focus.


The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually quiet.


The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. This job description does not constitute a contract for employment.