Anyone done pharmacy management?

[RuthENurse]

I am considering a pharmacy management job with Blue Cross

Here is the description: Under minimal supervision, perform prior authorization and post payment review of selected prescription medications to ensure the correct application of contract and policy benefits and to support the departmental and corporate objective of providing a high level of service to Blue Cross of Idaho (BCI) customers.

Has anyone done this type of work before? What were the pros and cons?

[nulife4good]

Hi,

I worked for Wellpoint Pharmacy Management and Anthem Blue Cross for a combination of 10 years. I also worked for HealthNet in the Prior Auth dept for prior auths. I started with the company as a phamacy technician and spent the remaining 5 years as a corporate trainer. I can't give you the perspective of the job as a licensed RN (since I wasn't one at the time) but I trained RNs, customer service reps, social workers, etc. and spent a great deal of time in the trenches aka on the unit floor with the staff. The majority of health care workers that I trained typically were those that had spent a few decades on unit floors and were ready for a big career change.

Since you'll be in a reviewing job here are the perks: You will have a wonderful set schedule that probably won't change--Mondays thru Fridays (no weekends or holidays) with a standard 9 to 5. You get to wear your own clothes! No more scrubs. You won't be on your feet all day since you'll have a desk--there may also be potential down the line for you to be able to telecommute. You won't be dealing with front-facing customer service--this is business lingo meaning you won't have to deal face to face with your actual client aka patients. You may be involved in new medication review presentations--in which Pharm Reps provide a lunch and learn, so you get to review the efficacy of new meds..and get fed too!

Here are some of the cons: Although you will work with minimal supervision, you will follow a script/protocol for reviewing prior auths. You don't get to think outside of the box because someone has already done it for you. If you're an independent and creative individual--you may feel restricted. You'll follow decision trees in order to render your decision. You will be on the phone...all day. You may not have the opportunity to interact with other staff members because...you will be on the phone..all day. Depending on the unit, there may be telephonic requirements that may need to be met for example: calls must be answered within 20 secs., calltimes shouldn't exceed beyond 2 min., etc. If you're not computer savy, you'll need to get up to speed since Anthem relies heavily on technology. You will deal with a lot, a lot of angry physicians and patients questioning why YOU have the authority to deny their medication.

Anthem is HUGE and there is the potential for you to transfer to several locations nationally--and you could eventually work from home.

The reason why I decided to quit the company was that I didn't ultimately find what I did for a living was fulfilling--I enjoy dealing with people face to face and I felt as though what I did wasn't making a huge difference. I'm still in contact with my former co-workers and drop by for lunch. Hence, my lifechanging decision to become an RN--I'm a new grad! The people are what made my time with the company enjoyable.

Hope this helps, sorry to write a novel. I'll be happy to answer more questions for you. Best of luck!