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Consultant Pharmacist Team Lead - Managed Care (remote) Job Number : 2024-46233
Category:
Healthcare Location : Shrewsbury, MA Shift:
Day Exempt/Non-Exempt:
Exempt Business Unit:
ForHealth Consulting Department:
ForHealth Consulting - Pharmacy - W401453 Job Type:
Full-Time Salary Grade:
P3 Num. Openings : 1 Post Date : May 28, 2024 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 regarding prior authorization for member prescriptions and client members' 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. MAJOR RESPONSIBILITIES: Provides orientation, training, guidance, and direction to Consultant Pharmacists and Pharmacy Associates. Prepares and 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 data entry and report generation, ensuring compliance with the federal twenty-four hour time limit. Participates in and coordinates 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 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. Provides 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 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. 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.
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Healthcare Location : Shrewsbury, MA Shift:
Day Exempt/Non-Exempt:
Exempt Business Unit:
ForHealth Consulting Department:
ForHealth Consulting - Pharmacy - W401453 Job Type:
Full-Time Salary Grade:
P3 Num. Openings : 1 Post Date : May 28, 2024 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 regarding prior authorization for member prescriptions and client members' 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. MAJOR RESPONSIBILITIES: Provides orientation, training, guidance, and direction to Consultant Pharmacists and Pharmacy Associates. Prepares and 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 data entry and report generation, ensuring compliance with the federal twenty-four hour time limit. Participates in and coordinates 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 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. Provides 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 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. 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.
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