Blue Cross And Blue Shield Association Harrisburg , PA 17101
Posted Yesterday
Position Description
Base pay is influenced by several factors including a candidate's qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more.
At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it's why our employees consistently vote us one of the "Best Places to Work in PA."
This position is responsible for the outbound phone calls to members, prescribers, and/or pharmacies to facilitate closure of pharmacy-related HEDIS and Medicare STAR gaps. The incumbent possesses good clinical/analytical skills and sound decision-making capabilities to identify opportunities/risks and propose strategies accordingly. Strong interpersonal and excellent communication skills are essential due to interaction with various members of the medical profession, managed care clients, and members. The incumbent also serves as a resource to providing clinical support to committees and workgroups such as HEDIS/NCQA and Medicare STARS.
Responsibilities and Qualifications
Clinical evaluation of medication therapy
Peer to Peer discussions with medical providers to discuss clinical recommendations
Contributes to program improvements by using continuous quality improvement processes, by being proactive in identifying improvement opportunities and by contributing on-going consultation and collaboration with product leaders
Collaborates on the refinement of consultation scripting; solicits and utilizes input from those contacted toward scripting improvements
Upholds clinical integrity of pharmaceutical solutions by staying up to date on medication information, contributing to the identification of pharmacy program best practices, collaborating with Medical Directors and Clinical Pharmacy staff
Other duties as assigned. Contributes creative solutions to improve operational efficiency and effectiveness of pharmacy team.
Skills:
Knowledge:
Experience:
Education and Certifications:
Location:
Work Environment:
Working environment includes typical office conditions.
Physical Demands:
Other:
Performs other related duties and assignments as directed.
Occasional overnight travel and travel between CBC locations.
About Us
We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a diverse and caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you'll help us live our mission of improving the health and well-being of our members and the communities in which they live.
Blue Cross And Blue Shield Association