Clinical Utilization Management Pharmacist

Clinical Pharmacist

Under the direction of the Pharmacy Utilization Management (UM) Supervisor, the Clinical Pharmacist is responsible for reviewing, processing and managing the daily caseload of pharmacy prior authorization (PA) requests for coverage determinations (CD), and exceptions. The Clinical Pharmacist ensures timely disposition of reviews for CD and exceptions by adherence to established timeframes. The Clinical Pharmacist consults as required with THP Medical Directors (MD) on prior authorization that fails to meet drug prior authorization (PA) criteria for coverage.

Key Responsibilities/Duties – what you will be doing (top five):

• Provides subject matter expertise for the integrated team and supports the member's medication management needs
• Provides clinical pharmacy services and support to members and providers
• Manages members with complex pharmaceutical needs in collaboration with the care team
• Completes medication review and reconciliation for members with complex medication regimen
• Serves as the medication expert for patients, providers, and care team members

Qualifications – what you need to perform the job

• Licensed to practice pharmacy in Massachusetts with pharmacy degree required
• Current and valid Massachusetts pharmacist license
• Certification by the Board of Pharmacy Specialties in a relevant area of pharmacy practice (e.g., BCACP, BCGP, BCPP, BCPS).

• Required (minimum): Doctor of Pharmacy (PharmD)
• Preferred: PharmD from an ACPE-accredited school of pharmacy strongly desired

• Required (minimum): 5 or greater years of progressive clinical pharmacy experience in managed care, facility, and retail setting. 2 years of related clinical experience in an ambulatory setting. Extensive knowledge of Medicare and MassHealth formularies. Care management, high-risk population, and/or transitions of care experience
• Preferred:

• Strong interpersonal skills with ability to manage build relationships and influence member behavior
• Autonomous practitioner with strong critical thinking skills
• Articulate with ability to present clinical and administrative information concisely
• Independent problem-solving ability with ability to manage conflict and build consensus
• Organizational skills with ability to prioritize based on deliverable timelines, member needs and contract requirements
• Ability to practice in an interdisciplinary team-based model

Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):

• Travel to members residence and outside meetings
• Must be able to work under normal office conditions and work from home as required.
• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
• May be required to work additional hours beyond standard work schedule.

Salary Range

$110,680.66 -$166,020.98

Compensation & Total Rewards Overview

The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company's sole discretion, consistent with the law.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

• Medical, dental and vision coverage
• Retirement plans
• Paid time off
• Employer-paid life and disability insurance with additional buy-up coverage options
• Tuition program
• Well-being benefits
• Full suite of benefits to support career development, individual & family health, and financial health

For more details on our total rewards programs, visit

We welcome all. All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

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