Fallon Health

  • Medicaid Clinical Pharmacist - Growing Health Plan

    Location US-MA-Worcester
    Posted Date 1 week ago(4/11/2018 3:33 PM)
    Job ID
    # Positions
  • Overview

    About Fallon Health

    Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.

    Brief Summary of Purpose:

    Primary responsibility is to provide a superior level of service and act in a consultative manner to ensure the growth and retention of ACO membership and partners.


    Provides clinical pharmacy support to Medicaid ACO and MCO members by:

    • Identifying members for interactive consultation based on risk stratification or predictive modeling
    • Performing medication reviews to identify medication related problems
    • Performing interactive consultations and making recommendations/interventions for members and providers, appropriately documents all pharmacotherapy interventions in internal case management tracking system
    • Interacting with members telephonically or in person to review and reconcile medications
    • Providing medication education telephonically or in-person to members
    • Communicating trends identified from medication reviews to prescribers and/or clinical team members
    • Receiving and responding to escalated calls regarding clinical or medication procurement issues
    • Researching and resolving provider clinical inquiries in regards to medication and disease state management
    • Designing and implementing targeted medication and disease management programs by analyzing medical and pharmacy utilization reports
    • Designing and implementing targeted medication and disease management programs to ensure compliance with CMS and EOHHS requirements and regulations
    • Providing in-service education related to medications, pharmacy or quality initiatives. In-services may be designed for internal or external audiences including members.
    • Assisting in implementation of new disease or medication management programs
    • Coordinating with internal departments and external clients on disease and/or medication management projects.
    • Reporting on clinical and financial outcomes of programs
    • Providing pharmacy clinical services and programs designed to coordinate with community health center and community based pharmacies
    • Provide required data and clinical reports for compliance and audits






    Current License to practice as pharmacist in Massachusetts without restriction.



    5 years with at least one year in a managed care environment

    1-2 years professional experience practicing as a clinical pharmacist


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