Managed Care Consultant Pharmacist IV – Remote
Overview
Managed Care Consultant Pharmacist IV - Remote
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 administers client-specific programs to provide clinical expertise regarding prior authorization for member prescriptions and client members’ drug therapy. This position participates in prospective and retrospective DUR activities, including handling live calls from physicians and pharmacists, reviewing appropriate drug therapy, coordinating and managing the prior authorization process, and contributing to the development of clinical drug use criteria. This role is 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 data entry and generation of related reports; ensures 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 cases and may represent the client during appeal processes regarding prescription medications
• Performs medication therapy management comprehensive and targeted 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
• Provides real-time drug therapy recommendations to prescribers
• Reviews clinical documentation submitted by treating physicians and pharmacists to determine medical necessity and program compliance
• Determines in real time via telephone communications with pharmacies the authorization or denial of prior approval requests for prescription medications
• Provides pharmaceutical expertise to advisory boards and 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
• Refs 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
• Performs 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.
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Salary: USD 72000 - 108000 per year
Experience: 5 years required
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Managed Care Consultant Pharmacist IV - Remote
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 administers client-specific programs to provide clinical expertise regarding prior authorization for member prescriptions and client members’ drug therapy. This position participates in prospective and retrospective DUR activities, including handling live calls from physicians and pharmacists, reviewing appropriate drug therapy, coordinating and managing the prior authorization process, and contributing to the development of clinical drug use criteria. This role is 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 data entry and generation of related reports; ensures 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 cases and may represent the client during appeal processes regarding prescription medications
• Performs medication therapy management comprehensive and targeted 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
• Provides real-time drug therapy recommendations to prescribers
• Reviews clinical documentation submitted by treating physicians and pharmacists to determine medical necessity and program compliance
• Determines in real time via telephone communications with pharmacies the authorization or denial of prior approval requests for prescription medications
• Provides pharmaceutical expertise to advisory boards and 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
• Refs 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
• Performs 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.
#J-18808-Ljbffr
Salary: USD 72000 - 108000 per year
Experience: 5 years required
Apply tot his job
Apply To this Job