Pharmacist, Principal-Medication Policy

Job Description

Your Role

The Medication policy team is primarily responsible for supporting the Blue Shield of California Pharmacy and Therapeutics (P&T) Committee process and supports the operational components of the Drug Authorization Program by ensuring that evidence based clinical criteria approved by the Blue Shield of California Pharmacy and Therapeutics Committee are implemented operationally in order to provide a quality, cost effective care. The Medication Policy pharmacist will report to the Senior Manager for Medication Policy.

Responsibilities

Your Work

In this role, you will :

• Develop, analyze & monitor prescription drug, medical claims, and program data to identify opportunities to improve quality and cost of healthcare and to monitor / report performance and outcomes.
• Develop project proposals for identified opportunities and support implementation.
• Serve as a BSC Pharmacy Services contact and subject matter expert to stakeholders, and manage external relationships (vendors, clients) related to assigned work.
• Support the operational implementation and maintenance of medication policies for drugs in the pharmacy and medical benefit.
• Support the configuration of clinical rules in the automated prior authorization system for both pharmacy and medical benefit drugs.
• Ensure compliance with various regulatory and quality accreditation requirements around drug utilization management in order to support safe, efficacious, and cost-effective prescribing.
• Provide support for the development and maintenance of Blue Shield of California drug formulary for all product lines.
• Provide pharmacotherapy expertise for the pharmacy program by supporting the Pharmacy and Therapeutics Committee, drug formulary, prior authorization, drug utilization review and physician reporting programs.
• Assist with the monitoring, tracking, and trending of coverage decisions derived from the Blue Shield P&T Committee formulary & utilization management decisions.

Qualifications

Your Knowledge and Experience

About the Team

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!

Our Values :

Our Workplace Model :

At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.

Two Ways of Working :

o Member-facing and approved out-of-state roles remain remote.

o Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.

o For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

Physical Requirements :

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office / deskwork - Activity level : Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity :

External hires must pass a background check / drug screen. Qualified applicants with arrest records and / or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.