Blue Cross & Blue Shield of Rhode Island · 4 hours ago
Pharmacy Program Specialist
Providence, RI
Full-time
Hybrid
Mid Level
$65K/yr - $97K/yr
3+ years expBlue Cross & Blue Shield of Rhode Island is dedicated to providing high-quality healthcare services. The Pharmacy Program Specialist will serve as a subject matter expert on pharmacy benefits, collaborating with internal teams to enhance program performance and support employer groups.
Insurance
Responsibilities
Serve as a subject matter expert on pharmacy benefit design and trend management; respond to inquiries regarding prescription coverage and member utilization
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
Deliver in person presentations and program performance updates; analyze data and track adoption of benefit options and coordinate cost-saving initiatives across departments
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
Review pharmacy benefit rules, resolve coverage issues, and ensure accurate adjudication of claims in alignment with benefit design
Support P&T Committee functions, manage internal requests and member outreach, and facilitate communication between pharmacists and providers for care coordination
Must have the ability to work onsite for internal department meetings and offsite for external client meetings and presentations
Perform other duties as assigned to maintain high-quality, cost-effective pharmacy benefit operations
Qualification
Required
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)
Preferred
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
Benefits
Flexible work arrangements that include remote and hybrid opportunities
Paid time off
Tuition reimbursement
Assist with student-loan repayment
Health, dental, and vision insurance
Programs that support your mental health and well-being
Competitive pay
Bonuses and investment plans
Additional paid time to volunteer
Company
Blue Cross & Blue Shield of Rhode Island
At Blue Cross & Blue Shield of Rhode Island (BCBSRI), we know that health is more than what happens at the doctor’s office.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Martha Wofford
President and CEO
James Joy
Chief Financial Officer - Retired
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