Pharmacist, Consultant
Company: Blue Shield of California
Location: El Dorado Hills
Posted on: June 29, 2025
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Job Description:
Your Role The Prior Authorization (PA) team utilizes clinical
knowledge to review authorization requests for coverage under the
outpatient pharmacy benefit. The Pharmacist, Consultant will work
as part of the pharmacy benefit Prior Authorization (PA) team to
support the Blue Shield of California (BSC) Pharmacy and
Therapeutics Committee (P&T) by ensuring that evidence based
clinical decisions are implemented appropriately to provide a
high-quality and cost-effective pharmacy benefit. The Pharmacist,
Consultant (Drug Utilization Review Pharmacist) will report to the
Drug Utilization Review (DUR) Pharmacist Manager. Your Work In this
role, you will: Support the clinical and operational implementation
of P&T approved policies for the pharmacy benefit, for both the
Commercial and Medicare lines of business Apply clinical expertise
to PA reviews and work collaboratively with the PA and Call Center
Teams to support access to safe, efficacious, and medically
necessary medications Operate in compliance with all regulatory and
accreditation requirements to ensure all requests are reviewed
within regulatory required timeframes Serve as a resource to
internal and external constituents regarding the Blue Shield drug
formulary, medication policies and appropriate drug use Embrace BSC
values by answering clinical and operational questions,
participating in group discussions, and supporting other team
members while working towards a collective goal Use clear and
concise communications and on-brand messaging when communicating
with providers or members Follow all corporate policies and
procedures Operate in compliance with all regulatory and
accreditation requirements, and corporate policies and procedures
regarding the support access to safe, efficacious, and medically
necessary medications Assist in preparing materials for audits and
reports; complete projects as assigned Your Knowledge and
Experience Requires a Doctor of Pharmacy (PharmD) degree Requires a
currently active and unrestricted California Registered Pharmacist
(RPh) license Requires at least 2 years of experience in clinical
pharmacy Excellent oral and written communication skills Thorough
knowledge of therapeutic use of medications
Keywords: Blue Shield of California, Fremont , Pharmacist, Consultant, Healthcare , El Dorado Hills, California
