Sr. Clinical Pharmacist
2 weeks ago
Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.
Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated.
We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.
The Senior Clinical Pharmacist will be responsible for leading the pharmacy formularies to ensure appropriate coverage and cost effectiveness.
Principal Duties and Responsibilities:
* P&T Committee support:
o Serves as the P&T Committee Secretary
o Prepares materials for committee members.
§ Annual review of existing utilization management criteria
§ Development of new criteria
o Collaborating with the PBM on materials presented to the P&T committee regarding new drug
* Drug Coverage Committee:
o Participates as the Chair of the Drug Coverage Committee
o Prepares materials for distribution to the committee members
* Development of the New Drug Review grid to present to Committee members
* Development and/or collaboration with the Clinical Pharmacy team on initiative to be presented
o Presents topics at meeting
* Disease Management Program:
o Assists in development and implementation of new programs
o Maintains and updates existing programs as clinically appropriate
* Formulary Trend Management:
o Develops and implements clinical pharmacy strategies which result in high-quality, cost-effective pharmacy management and outcomes
o Develops, analyzes, reports on clinical programs, handles and coordinates between Pharmacy and other collaborators throughout Mass General Brigham Health Plan.
o Develops, implements, and leads managed care programs such as prior authorization and quantity limitations programs
o Ensures clinical compliance with law and regulatory bodies
o Develops educational materials, newsletters, member, and provider talking points and disseminates clinical information for both internal and external audiences.
o Represents Mass General Brigham Health Plan at the MassHealth DUR Board meeting as needed
o Attends the ACO Pharmacy Workgroup committee
o Participates in other committees as requested
o Works with the Clinical Pharmacy Associates to ensure coding is accurate and reflects intent of the plan
* As needed day to day Clinical Pharmacy Operations including but not exclusively:
o Daily review of formulary issues:
§ Override requests
§ Correspond with providers about formulary alternatives
o Partners with Care Managers and CMA
o Coordinates with Pharmacy Benefits Manager on processing issues
o Works with Member Services on pharmacy issues
o Implements of formulary decisions
o Performs Specialty Pharmacy audits of prior authorization.
* Hold self and others accountable to meet commitments.
* Ensure diversity, equity, and inclusion are integrated as a guiding principle.
* Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
* Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.
* Other duties as assigned with or without accommodation.
Qualifications:
* Pharm D required or the equivalent combination of training and experience, plus 3 years of experience in managed care pharmacy.
* Valid Unrestricted Pharmacist License Required.
Skills/Abilities/Competencies:
* Demonstrate Mass General Brigham Health Plans core brand principles of always listening, challenging conventions, and providing value.
* Bring fresh ideas forward by listening to and working with employees and the people we serve.
* Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner.
* Strong, demonstrated track record of an ability to execute on time, on budget, and on scope.
* Strong aptitude for technology-based solutions.
* Ability to inject energy, when and where it's needed.
* Current in healthcare trends.
* Demonstrated forward, visionary thinking; ability to see "what is" and envision "what could be."
* Ability to develop, introduce, defend, and gain support for a new ideas and approaches.
* Excellent leadership skills and leadership track record.
* Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience, strong executive presence, presentation, and communication skills. Strong verbal, active listening, and written communication skills required.
* Ability to view the long-range trends and cycles of the business and industry and see the "big picture."
* Ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions.
* Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy.
* Excellent interpersonal skills, including the ability to influence others at all levels of an organization.
* Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
* Unquestionable integrity.
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