Consultant Pharmacist Team Lead - Managed Care (Remote)

Overview

GENERAL SUMMARY OF POSITION:

Under the general direction of the Associate Director or designee, the Consultant Pharmacist Team Lead functions as a team leader/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, and may oversee, 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, participating in the development of clinical drug use criteria, and the coordination of activities of the clinical workgroups of program advisory boards. This position will also be responsible for the orientation, training and direct or indirect supervision of the Consultant Pharmacists and Pharmacy Associates.

Responsibilities

MAJOR RESPONSIBILITIES:

• Provides orientation, training, guidance and direction, to Consultant Pharmacists and Pharmacy Associates

• Prepares and or coordinates client scheduled and ad hoc reports.

• Directs the activities of the advisory board clinical workgroups: chairs meetings, recruits participants, gathers information, writes reports, gathers and analyzes data and presents materials.

• Represents the program at client meetings.

• Represents the program at conferences, public forums, and informational meetings

• 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 ensuring compliance with the federal twenty-four hour time limit.

• Participates in and or coordinates 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 program planning and development.

• 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 OR

• Doctor of Pharmacy degree with 2 years of pharmacy-related work experience or Doctor of Pharmacy degree with 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

• Eligibility for licensure or current pharmacist license in good standing in the Commonwealth of Massachusetts

• Previous medical/profile review and medication review experience

• Ability to travel to off-site locations

PREFERRED QUALIFICATIONS:

• Bilingual fluency in reading, writing and speaking English and one other major language