Point32Health
Clinical Utilization Management Pharmacist
Canton, MA · Full-time
Sponsorship not specified$111k-$166kDetected 31 days ago
ExcelPerformance ManagementPharmacy PracticeResearchCommunicationCollaborationProblem SolvingCritical ThinkingOrganizational SkillsMicrosoft Office
About the role
- The Clinical Pharmacist ensures timely disposition of reviews for CD and exceptions by adherence to established timeframes.
- Communicates daily with members, providers and other external customers regarding status and disposition of cases
- Oversees and addresses any quality issues with pharmacy technicians and confer with other clinical pharmacist on review questions
Responsibilities
- We enjoy the important work we do every day in service to our members, partners, colleagues and communities.
Requirements
- A minimum of a Bachelor of Science degree in Pharmacy or PharmD
- Requires analytical ability to independently research/ summarize data on drug utilization and spend
- Strong PC skills with MS Office (Word, Excel, PowerPoint & Access) and ability to learn/use new database and reporting applications
- High degree of professionalism and confidence
- Ability to recognize politically sensitive issues and utilize diplomacy
- Ability to interact effectively with all levels of management
- Must be self-motivated and capable of working independently with minimal supervision
- Must be capable of organizing, facilitating and managing several projects simultaneously
Nice to have
- A minimum of 3 years full-time experience as a pharmacist, preferably PBM and/or managed care setting
- Expert knowledge of the principles and practices of pharmaceutical science.
- Working knowledge of Federal and state controlled substance and pharmacy laws, rules and regulations
- Knowledge of drug coding (NDC, GCN, GPI and USC) and NCPDP claims adjudication systems
- Previous working knowledge of MedHOK, RxClaim, CCMS and CAS system a plus
- Knowledge of or experience with Medicare Part B & D, Medicaid and Drug Utilization Management
- Prior authorization experience, including reviewing drug use criteria for medication approval
- PharmD from an ACPE-accredited school of pharmacy strongly desired
Skills
- Excellent written and verbal communication skills
Compensation
- $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
- 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.
Benefits
- Point32Health 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.
- 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.
- 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.
- Provides all aspects of clinical support needed to perform drug prior authorization (PA) requests and consults as required with THP Medical Directors (MD) on cases that fail to meet coverage criteria
Company info
- Point32Health 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.
- We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health.
- Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions.
- 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.
- Learn more about who we are at Point32Health.
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This listing is sourced directly from Point32Health's careers page and normalized into a canonical job model.