Clinical Utilization Management Pharmacist

Clinical PharmacistPoint32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it's at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.Job SummaryUnder 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 needsProvides clinical pharmacy services and support to members and providersManages members with complex pharmaceutical needs in collaboration with the care teamCompletes medication review and reconciliation for members with complex medication regimenServes as the medication expert for patients, providers, and care team membersQualifications – what you need to perform the jobLicensed to practice pharmacy in Massachusetts with pharmacy degree requiredCurrent and valid Massachusetts pharmacist licenseCertification 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 desiredRequired (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 experiencePreferred:Strong interpersonal skills with ability to manage build relationships and influence member behaviorAutonomous practitioner with strong critical thinking skillsArticulate with ability to present clinical and administrative information conciselyIndependent problem-solving ability with ability to manage conflict and build consensusOrganizational skills with ability to prioritize based on deliverable timelines, member needs and contract requirementsAbility to practice in an interdisciplinary team-based modelTravel to members residence and outside meetingsMust 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 -$166,020.98Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:Medical, dental and vision coverageRetirement plansPaid time offEmployer-paid life and disability insurance with additional buy-up coverage optionsTuition programWell-being benefitsFull suite of benefits to support career development, individual & family health, and financial healthWe welcome allAll 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.Scam Alert : Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact View email address on click.appcast.io