Pharmacy Program Specialist

Pay Range:

Please emailif you are a candidate seeking a reasonable accommodation for the application and/or interview process.

At BCBSRI our greatest resource is our people.

We come from varying backgrounds different cultures and unique experiences. We are hard-working caring and creative individuals who collaborate support one another and grow together. Passion empathy and understanding are at the forefront of everything we donot just for our members but for our employees as well.

We recognize that to do your best work you have to be your best self.
Its why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health dental and vision insurance as well as programs that support your mental health and well-being. We pay competitively offer bonuses and investment plans and are committed to growing and developing our employees.

Our culture is one of belonging.
We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where youre at in the organization youre an integral part of our team and your input thoughts and ideas are valued.

Join others who value a workplace for all.
We appreciate and celebrate everything that makes us unique from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders.

Were dedicated to serving Rhode Islanders.
Our focus extends beyond providing access to high-quality affordable and equitable care. To further improve the health and well-being of our fellow Rhode Islanders we regularly roll up our sleeves and get to work (literally) in communities all across the statebuilding homes working in food pantries revitalizing community centers and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can our associates receive additional paid time to volunteer.

What you will do:

• Pharmacy Benefit Expertise
  Serve as a subject matter expert on pharmacy benefit design and trend management; respond to inquiries regarding prescription coverage and member utilization.
• Cross-Functional Collaboration
  Work with internal teams (Sales Marketing Customer Service & Care Management) to triage and research customer needs analyze market dynamics and integrate strategies into the pharmacy benefit toolkit.
• Employer Group Support
  Deliver in person presentations and program performance updates; analyze data and track adoption of benefit options and coordinate cost-saving initiatives across departments.
• PBM Partnership Program Optimization & RFP Compliance
  Collaborate with PBM and internal teams to enhance reporting tools optimize programs and ensure compliance with benefit design and regulatory requirements. Gather and validate data for RFPs ensuring accurate timely responses to assigned questions.
• Claims Adjudication Oversight
  Review pharmacy benefit rules resolve coverage issues and ensure accurate adjudication of claims in alignment with benefit design.
• Administrative & Communication Management
  Support P&T Committee functions manage internal requests and member outreach and facilitate communication between pharmacists and providers for care coordination.
• In Person Presentations and Department Meeting Must have the ability to work onsite for internal department meetings and offsite for external client meetings and presentations.
• Additional Responsibilities
  Perform other duties as assigned to maintain high-quality cost-effective pharmacy benefit operations.

What youll need to succeed:

• Knowledge of formularies drug rebate contracts and pharmacy benefit design
• Knowledge of cost containment and utilization review strategies
• Analytical skills specific to pharmacy utilization management and/or project management.
• Strong communication interpersonal and presentation skills.
• Proficient in Microsoft Office applications (i.e. Excel PowerPoint)

The extras:

• Combination of education and applicable experience
• Three to five years experience in managed care or a pharmacy or related healthcare field.
• Specific knowledge and exposure to prescription drugs pharmacy benefits utilization review cost containment strategies and emerging technology.
• Experience with group level presentation and financial analysis reporting on pharmacy trends and benefit performance.

Location:
BCBSRI is headquartered in downtown Providence conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules based on role:

• In-office: onsite 5 days per week
• Hybrid: onsite 2-4 days per week
• Remote: onsite 0-1 days per week. Permitted to reside in the following states pending approval from the Human Resources Department: Arizona Connecticut Florida Georgia Louisiana Massachusetts North Carolina Oklahoma Rhode Island South Carolina Texas Virginia
  

Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do and it strengthens our ability to meet the challenges of todays healthcare industry. BCBSRI is an equal opportunity employer.

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