Consultant Pharmacy IV, Managed Care -Sourcing Requisition REMOTE

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Consultant Pharmacy IV, Managed Care - Sourcing Requisition REMOTE
Job Number:
Category: Healthcare
Location: Shrewsbury, MA
Shift: Day
Exempt/Non-Exempt: Exempt
Business Unit: ForHealth Consulting
Department: ForHealth Consulting - Pharmacy - W
Job Type: Full-Time
Num. Openings: 1
Post Date: May 5, 2025

This requisition is being used as a sourcing tool and does not have an open vacancy. Your application to this req will add you to a pool of candidates for potential future openings. We still encourage you to apply directly to positions you feel best meet your background, as this will not replace your application for other openings.

GENERAL SUMMARY OF POSITION:

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 is responsible for administering client-specific programs to provide clinical expertise in regards to prior authorization for member prescriptions and client members' drug therapy. This position will participate in 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, and participating in the development of clinical drug use criteria. This position will also be responsible for the orientation, training, and indirect supervision of the Consultant Pharmacists and Pharmacy Associates.

MAJOR RESPONSIBILITIES:

1. Provides orientation, training, guidance, and direction to Consultant Pharmacists and Pharmacy Associates.
2. Coordinates the request for prior authorization (RPA) process including data entry and report generation, ensuring compliance with the federal twenty-four hour time limit.
3. Participates in program planning and development.
4. Participates in the development of clinical drug use criteria for the DUR Program's prospective and retrospective review components.
5. Researches members' cases and may represent the client during appeal processes regarding prescriptions.
6. Performs medication therapy management, including comprehensive and targeted medication reviews of medical and medication profiles.
7. Reviews members' medical and medication profiles and interacts with healthcare providers and members to review appropriate drug therapy.
8. Provides real-time drug therapy recommendations to prescribers.
9. Reviews clinical documentation submitted by treating physicians and pharmacists to determine medical necessity and program compliance.
10. Decides in real time via telephone communications with pharmacies on prior approval requests for medications.
11. Provides pharmaceutical expertise to the advisory boards' clinical workgroups.
12. Monitors over- and under-utilization of prescribed medicines for members.
13. Assists in monitoring and researching profiles for compliance daily.
14. Refers suspected abuse and fraudulent members to the program manager or designee for review.
15. Participates in site visits to provider offices, as necessary.
16. Participates in agency meetings as requested.
17. Leads and participates in quality improvement and assurance initiatives.
18. Performs other related duties as assigned.

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 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 Massachusetts.
• Ability to travel to off-site locations.
• Previous medical and medication review experience.
• Bilingual fluency in reading, writing, and speaking English and another major language.

UMass Chan Medical School was among 23 companies that stood out as 2023 “DEI champions,” according to The Boston Globe.

Named a U.S. News & World Report “2023 BEST MEDICAL GRAD SCHOOL” for Primary Care and Research.