Lead Consultant Pharmacist
2 weeks ago
Overview
GENERAL SUMMARY OF POSITION:
Under the guidance of the Associate Director or their representative, the Lead Consultant Pharmacist serves as a pivotal member and leader within the drug utilization review and medication management therapy initiatives of Clinical Pharmacy Services (CPS). CPS is dedicated to implementing client-specific programs that offer clinical expertise regarding prior authorization for member prescriptions and the medication therapies of client members. This role will engage in, and may oversee, both prospective and retrospective DUR activities, which include, but are not limited to: managing live inquiries from healthcare providers, evaluating suitable drug therapies, coordinating and overseeing the prior authorization request process, contributing to the formulation of clinical drug use criteria, and orchestrating the activities of clinical workgroups within program advisory boards.
Responsibilities
MAJOR RESPONSIBILITIES:
- Facilitates orientation, training, and guidance for Consultant Pharmacists and Pharmacy Associates.
- Prepares and coordinates scheduled and ad hoc reports for clients.
- Leads the advisory board clinical workgroups: organizes meetings, recruits participants, compiles information, drafts reports, analyzes data, and presents findings.
- Acts as a representative of the program at client meetings.
- Represents the program at conferences, public forums, and informational sessions.
- Oversees the request for prior authorization (RPA) process, ensuring data entry and report generation comply with federal time constraints.
- Contributes to the development of clinical drug use criteria for both prospective and retrospective reviews within the DUR Program.
- Investigates member cases and may advocate for the client during appeal processes concerning prescription medications.
- Conducts comprehensive and targeted medication reviews of medical and medication profiles.
- Reviews member medical and medication profiles, collaborating with healthcare providers and client members to ensure appropriate drug therapy.
- Offers real-time drug therapy recommendations to prescribers.
- Evaluates clinical documentation from treating physicians and pharmacists to ascertain medical necessity and compliance with program standards.
- Determines, in real-time via telephone communication with pharmacies, the authorization or denial of prior approval requests for prescription medications.
- Provides pharmaceutical expertise and insights to the advisory board's clinical workgroups.
- Monitors both over-utilization and under-utilization of prescribed medications for members.
- Aids in the daily monitoring and research of profiles for compliance.
- Refers suspected cases of abuse and fraud to the program manager or their designee for further investigation.
- Participates in site visits to provider offices as required.
- Engages in program planning and development activities.
- Attends agency meetings as requested.
- Leads and participates in quality improvement and assurance initiatives.
- May undertake other job-related duties as assigned or requested.
Qualifications
REQUIRED QUALIFICATIONS:
- Bachelor of Science degree in Pharmacy with a minimum of 3 years of relevant work experience OR
- Doctor of Pharmacy degree with at least 2 years of pharmacy-related work experience or completion of a 2-year pharmacy residency OR
- Doctor of Pharmacy degree with completion of a 1-year pharmacy residency and 1 year of pharmacy-related work experience.
- Eligibility for licensure or a current pharmacist license in good standing.
- Prior experience in medical/profile review and medication review.
- Willingness to travel to off-site locations.
PREFERRED QUALIFICATIONS:
- Bilingual proficiency in reading, writing, and speaking English and one other major language.
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