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UM Clinical Pharmacist - Managed Care Experience Preferred -

Company: Fallon Community Health Plan
Location: Worcester
Posted on: October 10, 2018

Job Description:



Responsibilities: Primary Job Responsibilities:

  • Responsible for maintaining and updating the FH retail, specialty and medical Pharmacy Utilization Management criteria.
  • Coordinate with other FH pharmacists to manage UM criteria updates
  • Consult with internal and external stakeholders as needed
  • Consult with providers
  • Identify opportunities for interventions from high cost medication and medical cost lists and specific clinical pharmacy programs
  • Identify opportunities to improve quality measures (HEDIS, STARS, etc)
  • Review and provide clinical decisions for provider submitted prior authorizations for medically administered medications as well as pharmacy related appeals and grievances
  • Develop prior authorization criteria for new to market medications
  • Review and update existing prior authorization criteria
  • Perform in-services to pharmacists and other internal and external stakeholders as needed
  • Provide drug information to physicians and other health care providers.
  • Present clinical and economic data to Pharmacy and Therapeutics committee.
  • Participates in managing clinical issues resolution.
  • Participate in managing issues with medical and specialty drugs
  • Participate in general drug information support.
  • Participate in cost saving initiatives including but not limited to medical drug site of service conversions
  • Coordinate Site of Care Program for injectable medications
  • Plan and coordinate APPE student activities with other FH pharmacists and technicians

    Qualifications: Education:RPH or PharmDLicense: Current license to practice as Pharmacist in Massachusetts without restrictionExperience:5 years with at least one year in a managed care environment; 1-2 years professional expereince practicing as a Clinical Pharmacist.Competencies:
  • Able to evaluate clinical pharmacy data
  • Able to use computer data base, Access, Excel, and others
  • Able to evaluate economic pharmacy data
  • Able to write and orally communicate clinical and economic decisions to physicians and other health care personnel
  • Excellent communication skills, coordination and planning skills along with an ability to interact with a variety of audiences to build collaboration and consensus. PM16 5

    Keywords: Fallon Community Health Plan, Worcester , UM Clinical Pharmacist - Managed Care Experience Preferred -, Healthcare , Worcester, Massachusetts

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