Remote Consultant IV Pharmacy - Managed Care Sourcing Requisition

Job Overview

Join our esteemed Clinical Pharmacy Services (CPS) team as a Consultant Pharmacist IV, where you will be pivotal in enhancing drug utilization review and medication management initiatives. In this remote role, you will collaborate closely with the Manager and the Consultant Pharmacist Team Lead, engaging in critical activities such as live call handling, drug therapy reviews, and managing prior authorization workflows.

Key Responsibilities

• Mentor and train Consultant Pharmacists and Pharmacy Associates.
• Oversee the prior authorization request process, ensuring compliance with regulatory deadlines.
• Contribute to the formulation of clinical drug use criteria for both prospective and retrospective evaluations.
• Conduct thorough investigations into member cases and advocate for clients during appeal processes.
• Perform comprehensive medication therapy reviews, analyzing medical and medication histories.
• Engage in discussions regarding appropriate drug therapy with healthcare professionals and clients, providing timely recommendations.
• Review clinical documentation to ascertain medical necessity and adherence to program standards.
• Make real-time determinations on prior approval requests for prescription medications.
• Provide pharmaceutical expertise to advisory board clinical workgroups and partake in quality improvement efforts.
• Monitor medication utilization, addressing both over-utilization and under-utilization concerns.
• Assist with daily compliance assessments and refer any suspected cases of abuse or fraud for further investigation.
• Participate in site visits and attend relevant agency meetings as required.
• Undertake additional job-related responsibilities as assigned.
  
  

Required Skills

• Strong analytical and problem-solving capabilities.
• Excellent verbal and written communication skills.
• Proficiency in medication therapy management practices.
• In-depth knowledge of federal regulations and compliance standards.
• Ability to mentor and cultivate junior staff effectively.
• Bilingual proficiency in English and another major language is preferred.
  
  

Qualifications

• Bachelor of Science in Pharmacy with a minimum of 3 years of relevant experience, or
• Doctor of Pharmacy degree with 2 years of pharmacy-related experience or completion of a 2-year pharmacy residency, or
• Doctor of Pharmacy degree with 1 year of pharmacy residency and 1 year of pharmacy-related experience, or
• Doctor of Pharmacy degree with completion of a managed care residency program.
• Current eligibility or an active pharmacist license in good standing in the Commonwealth of Massachusetts.
• Willingness and ability to travel to off-site locations.
  
  

Career Growth Opportunities

This role presents a unique opportunity to expand your professional expertise in a supportive environment that values continuous learning and development. You will have the chance to engage in meaningful mentorship and contribute to innovative practices in clinical pharmacy.

Company Culture And Values

We pride ourselves on fostering an inclusive and collaborative work environment that prioritizes integrity, excellence, and the well-being of our clients. By joining our team, you will be part of a company committed to high standards of clinical care and compliance.

Networking And Professional Opportunities

As a Consultant Pharmacist IV, you will have access to a robust professional network and opportunities to collaborate on projects that influence the future of pharmacy practice, enabling you to build lasting professional relationships within the industry.

Employment Type: Full-Time