Clinical Pharmacist
Current• Review prior Authorization requests involving Formulary exception, Step Therapy and Quality Care Dosing limits to ensure it abides by blue cross blue shield of Massachusetts's medical policies.• Support BCBSMA Pharmacy Operations analysts in executing day-to-day approvals and denials in order to maintain compliance with all regulatory requirements.• Support the Home infusion therapy, specialty pharmacy Network and Medical Utilization Management for Pharmaceutical programs• Helped train new pharmacists on BCBSMA's medical policies and provide clinical guidance• Perform review of consumer grievance appeals from the member grievance department• Communicate and educate healthcare providers on prior authorization denials and strategize more cost-efficient solutions for medication management• Helped to ensure requests are reviewed in a timely manner in accordance to NCQA guidelines• Presented Botox medical policy for HIT/MED team consisting of pharmacists and pharmacy operations analysts• Gave feedback on certain medical policies and helped modify them
