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Clinical Pharmacy Consultant IV

1 month ago

Shrewsbury, Massachusetts, United States UMass Med School Full time
Overview

The Clinical Pharmacy Consultant IV plays a critical role in the drug utilization review and medication management therapy programs within Clinical Pharmacy Services (CPS). This position functions as a team member, providing clinical expertise in prior authorization for member prescriptions and client member drug therapy. The Consultant Pharmacist IV will participate in prospective and retrospective DUR activities, including handling live calls from physicians and pharmacists, reviewing appropriate drug therapy, and coordinating the request for prior authorization process.

Responsibilities
  • Provides orientation, training, guidance, and direction to Consultant Pharmacists and Pharmacy Associates.
  • Coordinates the request for prior authorization process, ensuring compliance with federal regulations.
  • Participates in program planning and development, including the development of clinical drug use criteria.
  • Researches member cases and represents the client during appeal processes regarding prescription medications.
  • Performs medication therapy management comprehensive and targeted medication reviews of medical and medication profiles.
  • Reviews member medical and medication profiles, interacting with healthcare 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 board's 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 agency meetings as requested.
  • Leads and participates in quality improvement and quality assurance initiatives.
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 completion of managed care residency program.
  • Eligibility for licensure or current pharmacist license in good standing in the Commonwealth of Massachusetts.
  • Ability to travel to off-site locations.
Additional Information
  • Previous medical and medication review experience.
  • Bilingual fluency in reading, writing, and speaking English and one other major language.