Description
In this role, you will be instrumental in overseeing drug utilization review and medication management therapy programs within Clinical Pharmacy Services (CPS). Working under the guidance of the Associate Director, you will provide clinical expertise for prior authorization and medication therapy while leading a team of Consultant Pharmacists and Pharmacy Associates to ensure high-quality care and efficient processes.
Key Responsibilities
- Team Leadership: Provide orientation, training, and ongoing support to Consultant Pharmacists and Pharmacy Associates.
- Report Coordination: Prepare and coordinate scheduled and ad hoc reports for clients.
- Advisory Board Management: Oversee advisory board clinical workgroups, chair meetings, recruit participants, and prepare reports.
- Client and Public Representation: Represent the program at client meetings, conferences, and public forums.
- Prior Authorization Process: Manage requests for prior authorization, ensuring compliance with time limits and generating relevant reports.
- Criteria Development: Contribute to the development of clinical drug use criteria for reviews.
- Case Research: Research member cases and represent clients during appeals regarding prescription medications.
- Medication Therapy Management: Conduct comprehensive medication reviews and provide recommendations to prescribers.
- Profile Reviews: Review medical and medication profiles and interact with healthcare providers to ensure appropriate drug therapy.
- Documentation Review: Assess clinical documentation for medical necessity and compliance.
- Real-Time Decisions: Make real-time decisions on medication approvals or denials via phone communication.
- Expertise and Monitoring: Provide pharmaceutical expertise to advisory boards and monitor medication use.
- Abuse Prevention: Identify and refer suspected abuse or fraudulent cases for further review.
- Site Visits and Planning: Participate in site visits, program planning, and development.
- Quality Initiatives: Lead quality improvement and assurance efforts.
- Additional Duties: Perform other job-related duties as needed.
Qualifications
Required:
- Bachelor's degree in Pharmacy with 3 years of experience, or a Doctor of Pharmacy degree with:
- 2 years of pharmacy-related experience, or
- 2 years of pharmacy residency, or
- 1 year of pharmacy residency and 1 year of pharmacy-related experience.
- Eligibility for licensure or current pharmacist license in good standing in Massachusetts.
- Experience with medical/profile and medication reviews.
- Ability to travel to off-site locations.
Preferred
- Bilingual fluency in English and another major language.
Employment Type: Full-Time