60 Independence Blue Cross Application Developer Jobs Hiring Near You

The Clinical Pharmacist is responsible for executing the daily activities associated with the clinical components of the pharmacy benefit. This position reviews data, resolves issues and coordinates tasks associated with pharmacy clinical programs. This position also provides clinical support to inter-disciplinary teams to improve healthcare outcomes, ensure patient safety, recommend cost-effective medication strategies, ensure compliance, and coordinate care efficiently and effectively.
Responsibilities
• Ensure clinically appropriate, cost-effective, and accurate formulary by providing appropriate drug review and formulary placement recommendations.
• Provide support for formulary maintenance such as but not limited to member, provider, and other external communication.
• Collaborate with cross-functional teams for various project work.
• Ensure all regulatory guidelines are met.
• Drug Information research as needed.
• Serve as subject matter expert and provide recommendations designed to address Medicare Part D associated Stars ratings that may have cascading effects to other important measures such as, but not limited to, Healthcare Effectiveness Data and Information Set (HEDIS), and Consumer Assessment of Healthcare Providers and Systems (CAHPS), National Committee for Quality Assurance [NCQA] Accreditation, the Quality Rating System (Commercial Exchanges) and Health Insurance Plan Rankings
• Identify underlying drivers of performance, develop and implement plans to improve ratings by working with internal departments and exploring external solutions.
• Present enterprise-wide ideas into structured Part D STARS meetings and recommend provider engagement strategies by supporting populating health
• Oversee monthly Acumen Patient Safety reports and track performance against industry benchmarks. Identify negative trends and communicate to key stakeholders. Ensure any outlier reports are managed and submitted to Center of Medicare & Medicaid Services (CMS) within the required timelines.
• Review CMS opioid monitoring system (OMS) reports, Drug monitoring program (DMP) reports and internal reports. Oversee of DMP program and complete quarterly submissions for the OMS program. Coordinate activities with other departments such as Corporation Finance Investigation Department (CFID) and enrollment as needed.
• Provide support for marketing materials related to pharmacy quality.
• Serve as the subject matter expert and pharmacy liaison to the member help, population health, health coach and operations teams to facilitate the creation of job aids and training materials
Required Qualifications
• Doctor of Pharmacy or Bachelor of Science Degree in Pharmacy with 5 years of relevant clinical experience
• Active State Pharmacy License
• At least 3 years practice managed care experience or accredited Managed Care Residency
• Strategic, self starter, ambitious, proactive
Preferred Experience
• Current knowledge and expertise in clinical pharmacology, disease management and managed care
• Experience with team-based care
• Self-management Skills - self-motivated, organized, detail oriented and manages time and resources effectively. Must be able to work independently in a collaborative environment, be self-directed and possess excellent organizational and time management skills
• Experience with STARS, Acumen and OMS submissions
• Computer/Technology Competency: Proficient in use of Microsoft Word, Excel, and Outlook
Hybrid
Independence has implemented a "Hybrid" model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the "Hybrid" model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey or Pennsylvania
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.