Job Description
All About Us
You likely know us as an insurance company, but that’s just a portion of what we do. Hundreds of thousands of North Dakotans trust us to provide them with personalized service and unmatched access to care. It’s a mission we take seriously.
We also work with entities throughout the state to challenge the cost and complexity of health care in North Dakota. This uncompromising goal requires caring, innovative people who are ready and willing to help create a new level of health and well-being in North Dakota and beyond.
Work environment This position offers flexibility for remote, hybrid, or in-office work arrangements. Candidates must hold active registration as a Pharmacist with the North Dakota Board of Pharmacy and reside within driving distance of Fargo, ND, to accommodate occasional onsite requirements. We empower our employees to find a work style that is best for them. Learn more at Life at Blue | BCBSND.
This position is eligible for internal Blue Cross Blue Shield employees and external applications.
Pay information - Pay Level: 027
- FLSA Category: Exempt – Salary
- Individual pay will be based on skills, experience, qualifications, location, internal equity, and other relevant factors.
- Opportunities for continued salary growth through a performance-based merit program.
- This position is eligible to participate in the company’s annual incentive program.
At BCBSND, we’re committed to providing fair and equitable compensation. While the posted salary range reflects the full compensation range for this role, offers typically fall at or below the midpoint, and in alignment with internal equity and role expectations. Individual offers are based upon candidates’ unique experience, education, and skillsets. The top of the range reflects the ceiling for this role and is only used for offers in exceptionally rare cases. We do not extend offers above the posted maximum.
A day in the life The Clinical Pharmacist serves as a primary resource for pharmacy-related reviews and information. This position evaluates and recommends reimbursement changes to pharmacy-related fee schedules and assists with new pharmacy code implementation, monitors drug utilization for appropriate use and works with management on the strategic development and direction of clinical pharmacy programs.
Your Responsibilities Will Include - Reviews medical pharmacy medication precertification requests and assists with retail and medical pharmacy appeals.
- Reviews pharmacy claims holds for appropriate billing, pricing, utilization, and medical necessity. Determines medical appropriateness by ensuring that a drug was used in accordance with Food and Drug Administration (FDA) labeling or a compendium recognized indication.
- Consults with internal staff on drug pricing issues, fee schedules, and/or resolving pharmacy-related member issues.
- Collaborates as a key member on internal and external pharmacy committees to ensure decisions are implemented accurately.
- Partners with external pharmacy partners on project and strategy implementation.
- Reviews utilization management policies for medications.
- Assists in developing policies and operations to ensure compliance to regulations and accreditation standards.
- Serves as an internal consultant/subject matter expert on pharmacy benefit issues, pharmaceutical technical questions, and pharmacy related medical procedure codes.
- Serves as the pharmacy subject matter expert as needed for internal and external stakeholders.
What You Need To Succeed - At least 3 years of experience as a registered pharmacist in a retail, clinic, hospital, or related pharmacy setting.
- Doctorate in Pharmacy is strongly preferred.
- Active registration as a Pharmacist with the North Dakota Board of Pharmacy.
- Strong attention to detail and a high level of accuracy in your work.
- Advanced technical and professional knowledge, with the ability to navigate complex systems and tools.
- Solid decision-making and analytical thinking skills to assess situations and determine appropriate actions.
- Effective interpersonal communication skills to collaborate with team members and engage with patients or providers.
- Clinical expertise that supports sound judgment and quality care in pharmacy practice.
Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards Benefits - Affordable medical, dental and vision coverage accepted throughout the United States
- Employer funded Lifestyle Spending Accounts, Health Savings Accounts and Health Reimbursement Arrangements
- Employer-paid life and disability insurance
- 401(k) retirement plan with company match and immediate vesting
- Paid holidays, paid time off (PTO), PTO donation program, and paid parental leave
- Voluntary benefits including Accident, Hospital Indemnity, Critical Illness, Term/Whole Life, Cancer Care Insurance, and more.
Additional Company Perks - Robust mental health offerings including an Employee Assistance Program, Learn to Live, meQ.
- Comprehensive learning and development opportunities and an Educational Assistance Program.
- 16 hours of paid volunteer time with a $200 donation to a charity of your choice upon completion of all volunteer hours.
- Employee recognition, community initiative events and yearly company outings.
- Workplace flexibility offering different options for working arrangements and the freedom to make time for important commitments.
- Opportunities to connect through employee committees.
Equal opportunity employment Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.
For questions, please email careers@bcbsnd.com.
This job posting will be closed 10/24/2025 at 8:00 a.m. (CT). No further applications will be considered.
Job Tags
16 hours, Full time, Contract work, Work at office, Immediate start, Remote work,