Consultant Pharmacist Team Lead - Managed Care (remote)

About the position

The Consultant Pharmacist Team Lead at UMass Chan Medical School is responsible for leading a team within the Clinical Pharmacy Services (CPS) to manage drug utilization review and medication management therapy programs. This role involves overseeing prior authorization processes, providing clinical expertise, and ensuring compliance with regulations while training and supervising other pharmacists and pharmacy associates.

Responsibilities
• Provides orientation, training, guidance and direction to Consultant Pharmacists and Pharmacy Associates
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• Prepares and coordinates client scheduled and ad hoc reports
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• Directs the activities of the advisory board clinical workgroups, chairs meetings, recruits participants, gathers information, writes reports, gathers and analyzes data and presents materials
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• Represents the program at client meetings
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• Represents the program at conferences, public forums, and informational meetings
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• Coordinates the request for prior authorization (RPA) process including data entry and report generation
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• Participates in and coordinates the development of clinical drug use criteria for the DUR Program
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• Researches member cases and may represent the client during appeal processes regarding prescription medications
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• Performs medication therapy management comprehensive and targeted medication reviews
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• Reviews members medical and medication profiles and interacts with healthcare providers and client members
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• Provides real-time drug therapy recommendations to prescribers
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• Reviews clinical documentation to determine medical necessity and program compliance
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• Decides in real time via telephone communications with pharmacies the authorization or denial of prior approval requests
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• Provides pharmaceutical expertise to advisory boards clinical workgroups
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• Monitors over-utilization and under-utilization of prescribed medicines
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• Assists in monitoring and researching profiles for compliance
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• Refers suspected abuse and fraudulent members for case review
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• Participates in site visits to Provider offices as necessary
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• Participates in program planning and development
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• Leads and participates in quality improvement and quality assurance initiatives
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• May perform other job-related duties as assigned or requested.

Requirements
• Bachelor of Science degree in Pharmacy with 3 years of work experience
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• Doctor of Pharmacy degree with 2 years of pharmacy-related work experience
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• Doctor of Pharmacy degree with completion of 2 years of pharmacy residency
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• Doctor of Pharmacy degree with completion of 1 year of pharmacy residency and 1 year of pharmacy-related work experience
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• Eligibility for licensure or current pharmacist license in good standing in Massachusetts
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• Previous medical/profile review and medication review experience
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• Ability to travel to off-site locations

Nice-to-haves
• Bilingual fluency in reading, writing and speaking English and one other major language

Benefits

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