Consultant Pharmacy IV, Managed Care -Sourcing Requisition REMOTE

University of Massachusetts Medical School; Shrewsbury; Remote; USD 60,000 - 100,000; Full time

Job summary

Join a forward-thinking institution as a Consultant Pharmacist IV, where you'll play a pivotal role in enhancing medication management and drug utilization review programs. This exciting position involves collaborating with healthcare providers to ensure optimal drug therapy for clients, training pharmacy staff, and leading quality improvement initiatives. You'll leverage your pharmacy expertise to make real-time decisions on medication approvals and contribute to clinical guidelines. If you're passionate about improving patient care and thrive in a dynamic environment, this role offers a unique opportunity to make a significant impact in the healthcare field.

Qualifications

• 3 years of experience in pharmacy or 2 years with a Doctor of Pharmacy degree.
• Eligibility for licensure in Massachusetts required.

Responsibilities

• Provide training and guidance to pharmacy staff.
• Coordinate prior authorization requests and ensure compliance.
• Conduct medication reviews and provide therapy recommendations.

Skills

Pharmaceutical Expertise

Medication Therapy Management

Clinical Drug Use Criteria Development

Communication Skills

Bilingual Fluency

Education

Bachelor of Science in Pharmacy

Doctor of Pharmacy

Job description

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Consultant Pharmacy IV, Managed Care -Sourcing Requisition REMOTE Job Number: 2025-48064
Category: Healthcare
Location: Shrewsbury, MA
Shift: Day
Exempt/Non-Exempt: Exempt
Business Unit: ForHealth Consulting
Department: ForHealth Consulting - Pharmacy - W401453
Job Type: Full-Time
Num. Openings: 1
Post Date: May 5, 2025

This requisition is being used as a sourcing tool and does not have an open vacancy. Your application to this req will add you to a pool of candidates for potential future openings. We still encourage you to apply directly to positions you feel best meet your background, as this will not replace your application for other openings.

GENERAL SUMMARY OF POSITION:

Under the general direction of the Manager or Consultant Pharmacist Team Lead or designee, the Consultant Pharmacist IV functions as a team member of the drug utilization review and medication management therapy programs within Clinical Pharmacy Services (CPS). CPS is responsible for administering client-specific programs to provide clinical expertise in regards to prior authorization for member prescriptions and client members drug therapy. This position will participate in prospective and retrospective DUR activities including, but not limited to: handling live calls from physicians and pharmacists, reviewing appropriate drug therapy, coordinating and managing the request for prior authorization process, and participating in the development of clinical drug use criteria. This position will also be responsible for the orientation, training and indirect supervision of the Consultant Pharmacists and Pharmacy Associates.

MAJOR RESPONSIBILITIES:

• Provides orientation, training, guidance and direction, to Consultant Pharmacists and Pharmacy Associates
• Coordinates the request for prior authorization (RPA) process including the data entry and the generation of reports that stem from this process, as well as ensure compliance with the federal twenty-four hour time limit.
• Participates in program planning and development.
• Participates in the development of clinical drug use criteria for the prospective and retrospective review components of the DUR Program.
• Researches members case and may represent the client during appeal processes regarding prescription medications.
• Performs medication therapy management comprehensive and targeted medication reviews of medical and medication profiles
• Reviews members medical and medication profiles and interacts with health care providers and client members to review appropriate drug therapy.
• Provide real-time drug therapy recommendations to prescribers
• Reviews clinical documentation submitted by treating physicians and pharmacists to determine medical necessity and program compliance.
• Decides in real time via telephone communications with pharmacies the authorization or denial of prior approval requests for prescription medications.
• Provides pharmaceutical expertise and knowledge to the advisory boards clinical workgroups.
• Monitors over-utilization and under-utilization of prescribed medicines for members.
• Assists in monitoring and researching profiles for compliance on a daily basis.
• Refers suspected abuse and fraudulent members to the program manager or designee for case review.
• Participates in site visits to Provider offices, as necessary.
• Participates in agency meetings as requested.
• Leads and participates in quality improvement and quality assurance initiatives
• May perform other job related duties as assigned or requested.

REQUIRED QUALIFICATIONS:

• Bachelor of Science degree in Pharmacy with 3 years of work experience OR
• Doctor of Pharmacy degree with 2 years of pharmacy-related work experience or completion of 2 years of pharmacy residency OR
• Doctor of Pharmacy degree with completion of 1 year of pharmacy residency and 1 year of pharmacy-related work experience OR
• Doctor of Pharmacy degree with completion of managed care residency program
• Eligibility for licensure or current pharmacist license in good standing in the Commonwealth of Massachusetts
• Ability to travel to off-site locations
• Previous medical and medication review experience
• Bilingual fluency in reading, writing and speaking English and one other major language

UMass Chan Medical School was among 23 companies that stood out as 2023 “DEI champions,” according toThe Boston Globe.

Named a U.S. News & World Report
“2023 BEST MEDICAL GRAD SCHOOL”
for Primary Care and Research