Managed Care Consultant Pharmacist IV - REMOTE

UMass Chan Medical School; Westborough (MA); On-site; USD 110,000 - 145,000; Full time

Job summary

University of Massachusetts Chan Medical School seeks a Consultant Pharmacist IV to join Clinical Pharmacy Services. You will lead DUR-related activities, review and optimize drug therapy, and coordinate prior authorization processes while supervising Pharmacists and Pharmacy Associates.

The role requires licensure in good standing, pharmacy residency or equivalent experience, and willingness to travel to off-site locations. Expect diverse clinical duties and ongoing professional development.

Qualifications

• Bachelor of Science degree in Pharmacy; 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

Responsibilities

• Provides orientation, training and guidance to Consultant Pharmacists and Pharmacy Associates
• Coordinates the prior authorization (RPA) process including data entry and reporting, ensuring 24-hour turnaround
• Participates in program planning and development
• Develops clinical drug use criteria for prospective and retrospective DUR reviews
• Researches member cases and represents client during prescription appeals
• Performs medication therapy management reviews of medical and medication profiles
• Reviews profiles and communicates with providers to optimize therapy
• Provides real-time drug therapy recommendations to prescribers
• Reviews documentation to determine medical necessity and compliance
• Decides authorization or denial of prior approvals via telephone with pharmacies
• Provides expertise to advisory boards and workgroups
• Monitors utilization patterns and identifies over/underutilization
• Assists in monitoring and researching member profiles for daily compliance
• Refers suspected abuse to program manager for case review
• Participates in provider site visits and agency meetings
• Leads or participates in quality improvement initiatives
• Performs other duties as assigned

Job description

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

Preferred Qualifications

• Previous medical and medication review experience
• Bilingual fluency in reading, writing and speaking English and one other major language

The University of Massachusetts Chan Medical School welcomes all qualified applicants and complies with all state and federal anti-discrimination laws.