Senior Consultant Pharmacist - Clinical Pharmacy Services

Description

In this role, you will be an integral member of our Clinical Pharmacy Services (CPS) team, directly impacting drug utilization review and medication management programs. Under the supervision of the Manager or Consultant Pharmacist Team Lead, you will be involved in several critical activities, including handling live calls, reviewing drug therapies, and managing prior authorization processes. You will also mentor other Consultant Pharmacists and Pharmacy Associates, maintaining high clinical care standards and compliance with federal regulations.

Key Responsibilities

• Mentorship and Training: Provide orientation, training, and continuous support to Consultant Pharmacists and Pharmacy Associates.
• Prior Authorization Coordination: Oversee the request for prior authorization (RPA) process, ensuring data entry, compliance with federal time limits, and report generation.
• Program Development: Contribute to the creation and refinement of clinical drug use criteria for both prospective and retrospective reviews within the DUR Program.
• Case Research: Investigate member cases and represent clients in appeal processes for prescription medications.
• Medication Therapy Management: Conduct thorough and targeted medication reviews, evaluating medical and medication profiles.
• Clinical Interaction: Discuss appropriate drug therapy with healthcare providers and client members, providing real-time recommendations.
• Documentation Review: Assess clinical documentation for medical necessity and adherence to program guidelines.
• Authorization Decisions: Make on-the-spot decisions regarding prior approval requests for prescription medications via telephone communication with pharmacies.
• Pharmaceutical Expertise: Offer expertise to advisory board clinical workgroups and participate in quality improvement initiatives.
• Utilization Monitoring: Identify and address over-utilization and under-utilization of prescribed medications.
• Compliance Monitoring: Assist in daily compliance checks and escalate suspected abuse or fraud cases for investigation.
• Site Visits and Meetings: Attend site visits to provider offices and agency meetings as necessary.
• Additional Duties: Complete other job-related tasks as assigned.
  
  

Qualifications

• Required Qualifications:
• Bachelor of Science in Pharmacy with 3 years of relevant experience; or
• Doctor of Pharmacy degree with 2 years of pharmacy-related experience or completion of 2 years of pharmacy residency; or
• Doctor of Pharmacy degree with 1 year of pharmacy residency and 1 year of pharmacy-related experience; or
• Doctor of Pharmacy degree with completion of a managed care residency program.
• Eligibility for or current pharmacist license in good standing in the Commonwealth of Massachusetts.
• Willingness to travel to off-site locations.
  

Additional Information

• Previous experience in medical and medication reviews is highly desirable.
• Bilingual proficiency in English and one other major language is preferred.
  
  

Employment Type: Full-Time