Qualifications:
Qualifications: Education: • Licensed in the state of Massachusetts as a Pharmacist. • Bachelor of Pharmacy. Preferred/Desirable: • Pharmacy & Therapeutics Committee experience. • Doctor of Pharmacy. Experience: • 1-2 year's clinical experience. Preferred/Desirable: • Pharmacy & Therapeutics Committee experience • Managed Care experience Certification or Conditions of Employment: • Valid unrestricted Massachusetts state pharmacy licensure Competencies, Skills, and Attributes: • Extensive knowledge of drug products, medical therapeutics, pharmacokinetics, and disease states. • Must be proficient in Microsoft Office • Strong written and verbal skills • Demonstrated ability to review & analyze data Working Conditions and Physical Effort: • Regular and reliable attendance is an essential function of the position. • Occasional travel (<5%) may be required • Ability to work in a fast paced environment
Responsibilities:
Job Summary: Reporting to the Director of Pharmacy Services and Provider Programs and working in conjunction with the Pharmacy Manager, the Clinical Pharmacist I is primarily responsible for the pharmacy utilization management (UM) activities, including review of all pharmacy prior authorization requests, oversight of the UM activities of the Pharmacy Services support staff, and maintenance of existing pharmacy UM programs. In addition, the Clinical Pharmacist I supports the department by coordinating the activities of the health plan's pharmacy benefits manager (PBM) and formulary advisory committees. The Clinical Pharmacist I may also participate in care management activities as needed. Key Functions/Responsibilities: • Ensure that pharmacy prior authorization decisions are consistent with covered benefits, quality of care and medically necessity. • Ensure that pharmacy prior authorization requests and decisions are properly evaluated, documented and meet all applicable utilization management turn-around times. • Responsible for insuring pharmacy programs meet applicable industry, regulatory, accreditation and contractual standards or laws. • Researches new prescription drugs or new applications of existing drugs and develops prescription drug use recommendations. • Works with the (PBM) to identify areas of potential cost-saving and quality improvement. • Gathers clinical and financial information for presentation to the health plan's Pharmacy and Therapeutics Committee. • Participates on clinical committees as necessary. • Conducts medication reconciliation outreach phone calls to members enrolled in care management programs Job Summary: Reporting to the Director of Pharmacy Services and Provider Programs and working in conjunction with the Pharmacy Manager, the Clinical Pharmacist I is primarily responsible for the pharmacy utilization management (UM) activities, including review of all pharmacy prior authorization requests, oversight of the UM activities of the Pharmacy Services support staff, and maintenance of existing pharmacy UM programs. In addition, the Clinical Pharmacist I supports the department by coordinating the activities of the health plan's pharmacy benefits manager (PBM) and formulary advisory committees. The Clinical Pharmacist I may also participate in care management activities as needed. Key Functions/Responsibilities: • Ensure that pharmacy prior authorization decisions are consistent with covered benefits, quality of care and medically necessity. • Ensure that pharmacy prior authorization requests and decisions are properly evaluated, documented and meet all applicable utilization management turn-around times. • Responsible for insuring pharmacy programs meet applicable industry, regulatory, accreditation and contractual standards or laws. • Researches new prescription drugs or new applications of existing drugs and develops prescription drug use recommendations. • Works with the (PBM) to identify areas of potential cost-saving and quality improvement. • Gathers clinical and financial information for presentation to the health plan's Pharmacy and Therapeutics Committee. • Participates on clinical committees as necessary. • Conducts medication reconciliation outreach phone calls to members enrolled in care management programs
•
Last updated on Aug 5, 2015