Senior Clinical Pharmacist, Medicare Trend, Cost of Care & Innovation

Job Description

The Medicare Cost of Care Pharmacist supports Blue Cross NC’s pharmacy cost management and affordability strategy by monitoring utilization and cost trends, identifying opportunities to improve value, and executing pharmacy initiatives that enhance program performance. This role collaborates across the enterprise—including formulary, utilization management, analytics, actuarial, product, and PBM partners—to ensure clinically appropriate, financially responsible, and compliant pharmacy outcomes.

What You'll Do

• Strategic Trend Analysis: Identify and respond to emerging cost drivers; perform clinical deep dives and monitor the high-cost drug pipeline for opportunities to evaluate and mitigate cost drivers.

• Formulary & UM Design: Advise on annual formulary changes, Part B step therapy and clinical UM criteria based on trend analysis

• Clinical Innovation: Launch and monitor new initiatives like clinical DUR (cDUR) programs; Use trend drivers to grow High Touch Rx connectivity and opportunities with analytics to enhance program performance; connect with team analyst on quality review of Part D and Part B claims

• Data Partnership: Act as the clinical liaison to analytics and strategy teams, refining tools to track pharmacy programs such as quantity limit rationalization and GLP-1 oversight.

• Cross-Functional Cooperation: Partner with Cost of Care, Actuary, Government Markets, and PBM stakeholders to ensure financial and clinical goals are met.

• Collaboration & Leadership:

  • Active participation in Medical Economics meetings, A&U, and Disease State Workgroups (such as Diabetes).

  • Direct support for P&T Committee activities and future-state planning.

  • Opportunities for mentorship and management of pharmacy students and residents.

What You Bring

• Bachelor's degree or advanced degree

• 5+ years of experience in related field

• In lieu of degree, 7+ years of experience in related field

• Licensed pharmacist or eligible for licensure in North Carolina

Bonus Points (preferred qualifications)

• PharmD

• Managed care, Medicare, formulary, and/or PBM experience preferred

• Demonstrated analytical, communication, and cross‑functional collaboration skills

What You’ll Get

• The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community  
• Work-life balance, flexibility, and the autonomy to do great work   
• Medical, dental, and vision coverage along with numerous health and wellness programs   
• Parental leave and support plus adoption and surrogacy assistance   
• Career development programs and tuition reimbursement for continued education   
• 401k match including an annual company contribution   
• Learn more 

Where You’ll Work

Our Hybrid Flex approach is built on presence with a purpose – giving you flexibility to work remotely with intentional in-person connection – that supports a workplace that’s flexible, connected, and future focused.

In a Hybrid-Flex role, you’ll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you’ll work virtually, with a few in-office visits each year for meaningful moments that matter.

Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets,  licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. 

*Based on annual corporate goal achievement and individual performance.
 

$118,691.00 - $189,906.00

Skills

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