Job Description
Overview
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 member’s 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.
Responsibilities
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 member’s 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 member’s 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 board’s 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
Qualifications
REQUIRED QUALIFICATIONS:
Bachelor of Science degree in Pharmacy with 3 years of work experience
Doctor of Pharmacy degree with 2 years of pharmacy‑related work experience or completion of 2 years of pharmacy residency
Doctor of Pharmacy degree with completion of 1 year of pharmacy residency and 1 year of pharmacy‑related work experience
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
Additional Information
PREFERRED QUALIFICATIONS:
Previous medical and medication review experience
Bilingual fluency in reading, writing and speaking English and one other major language
#J-18808-Ljbffr University of Massachusetts Medical School
Job Tags
Remote job, Work experience placement,