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Lead Consultant Pharmacist

2 months ago

Shrewsbury, Massachusetts, United States InsideHigherEd Full time

Position Overview:

As a pivotal member of the Clinical Pharmacy Services (CPS) team, the Lead Consultant Pharmacist operates under the guidance of the Associate Director or designated representative. This role is integral to the drug utilization review and medication management therapy initiatives. CPS is dedicated to delivering specialized clinical support concerning prior authorization for member prescriptions and the medication therapies of client members.

Key Responsibilities:

  • Facilitates orientation, training, and mentorship for Consultant Pharmacists and Pharmacy Associates.
  • Coordinates and prepares scheduled and on-demand reports for clients.
  • Leads advisory board clinical workgroup activities, including meeting facilitation, participant recruitment, data collection, report writing, and data analysis.
  • Acts as a representative for the program in client meetings and at various conferences and public forums.
  • Oversees the request for prior authorization (RPA) process, ensuring timely data entry and report generation while adhering to compliance standards.
  • Contributes to the formulation of clinical drug use criteria for both prospective and retrospective reviews within the DUR Program.
  • Investigates member cases and may advocate for clients during appeals related to prescription medications.
  • Conducts comprehensive and targeted medication reviews, focusing on medication therapy management.
  • Engages with healthcare providers and client members to evaluate and recommend appropriate drug therapies.
  • Provides immediate drug therapy recommendations to prescribers based on real-time evaluations.
  • Reviews clinical documentation from treating physicians and pharmacists to assess medical necessity and compliance with program standards.
  • Determines authorization or denial of prior approval requests for prescription medications through direct communication with pharmacies.
  • Offers pharmaceutical expertise to advisory board clinical workgroups.
  • Monitors medication utilization patterns to identify over-utilization or under-utilization among members.
  • Assists in daily compliance monitoring and profile research.
  • Refers suspected cases of abuse or fraud to the program manager for further investigation.
  • Participates in site visits to healthcare provider offices as needed.
  • Engages in program planning and development initiatives.
  • Attends agency meetings as required.
  • Contributes to quality improvement and assurance projects.
  • May undertake additional job-related duties as assigned.

Qualifications:

  • Bachelor of Science in Pharmacy with a minimum of three years of relevant experience OR
    • Doctor of Pharmacy degree with two years of pharmacy-related experience or completion of a two-year pharmacy residency OR
    • Doctor of Pharmacy degree with one year of pharmacy residency and one year of pharmacy-related experience.
  • Eligibility for licensure or current pharmacist license in good standing.
  • Prior experience in medical/profile review and medication assessments.
  • Willingness to travel to various locations as required.

Preferred Qualifications:

  • Bilingual proficiency in English and another major language.