Job Description

Overview

POSITION SUMMARY:

Under the general direction of the Manager or Consultant Pharmacist Team Lead or designee, the Consultant Pharmacist II functions as a team member of the drug utilization review programs within Clinical Pharmacy Services (CPS). CPS is responsible for administering client-specific programs to provide clinical expertise in regards to prior authorization for member prescriptions and client member’s drug therapy. This position handles live calls from physicians and pharmacists to review appropriate drug therapy and determine approval or denial of these real time prescriptions with increasing independence. The incumbent of this position will also review requests for prior authorization and determine approval or denial of these requests. The Consultant Pharmacist II serves as a resource for Consultant Pharmacist I staff.

Responsibilities

ESSENTIAL FUNCTIONS:

• Participates in orientation and training of Consultant Pharmacist I staff.
• Reviews clinical documentation submitted by treating physicians and pharmacists to determine medical necessity and program compliance with increasing independence.
• Decides in real time via telephone communications with pharmacies the authorization or denial of prior approval requests for prescription medications.
• Provides pharmaceutical expertise and knowledge to advisory board’s clinical workgroups.
• Monitors over-utilization and under-utilization of prescribed medicines for members.
• Assists in monitoring and researching profiles for compliance on a daily basis.
• Refers suspected abuse and fraudulent members to program management or designee for case review.
• Participates in site visits to client offices, as necessary.
• Participates in quality improvement and quality assurance initiatives.
• Perform other duties as required.

Qualifications

REQUIRED QUALIFICATIONS

• Bachelor of Science degree in Pharmacy with 2 years of pharmacy-related work experience OR
  • Doctor of Pharmacy degree with 1 year of pharmacy-related work experience OR
  • Doctor of Pharmacy Degree with completion of 1 year of pharmacy residency
• Eligibility for licensure or current pharmacist license in good standing in the Commonwealth of Massachusetts
• Ability to travel to off-site locations.

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