Fallon Health

  • UM Clinical Pharmacist - Managed Care Experience Preferred

    Location US-MA-Worcester
    Posted Date 2 months ago(7/3/2018 3:50 PM)
    Job ID
    5301
    # Positions
    1
    Category
    Pharmacy
  • 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.

    Summary:

    • Responsible for maintaining and updating the FH retail, specialty and medical Pharmacy Utilization Management criteria.
    • Develop utilization management criteria for new to market medications and update existing criteria based on FDA approved changes to indications or dosing and clinical guidelines.
    • Responsible for reviewing medications, performing drug utilization reviews, clinical/economic evaluation of therapies, and writing criteria sets for medications that have utilization management.
    • Review and provide clinical decisions for provider submitted prior authorizations for medically administered medications and pharmacy related appeals and grievances.
    • Responsible for Site of Care Program for injectable medications and home infusion.
    • Develop and implement programs designed to improve pharmacy related HEDIS and STAR measures, cost savings, or other clinical programs that improve member health and experience.
    • Primary preceptor for APPE students

    Responsibilities

    Primary Job Responsibilities:

    • Responsible for maintaining and updating the FH retail, specialty and medical Pharmacy Utilization Management criteria.
    • Coordinate with other FH pharmacists to manage UM criteria updates
    • Consult with internal and external stakeholders as needed
    • Consult with providers
    • Identify opportunities for interventions from high cost medication and medical cost lists and specific clinical pharmacy programs
    • Identify opportunities to improve quality measures (HEDIS, STARS, etc)
    • Review and provide clinical decisions for provider submitted prior authorizations for medically administered medications as well as pharmacy related appeals and grievances
    • Develop prior authorization criteria for new to market medications
    • Review and update existing prior authorization criteria
    • Perform in-services to pharmacists and other internal and external stakeholders as needed
    • Provide drug information to physicians and other health care providers.
    • Present clinical and economic data to Pharmacy and Therapeutics committee.
    • Participates in managing clinical issues resolution.
    • Participate in managing issues with medical and specialty drugs
    • Participate in general drug information support.
    • Participate in cost saving initiatives including but not limited to medical drug site of service conversions

    • Coordinate Site of Care Program for injectable medications

    • Plan and coordinate APPE student activities with other FH pharmacists and technicians

    Qualifications

    Education:

    RPH or PharmD

     

    License:

    Current license to practice as Pharmacist in Massachusetts without restriction

     

    Experience:

    5 years with at least one year in a managed care environment; 1-2 years professional expereince practicing as a Clinical Pharmacist.

     

    Competencies:

    • Able to evaluate clinical pharmacy data
    • Able to use computer data base, Access, Excel, and others
    • Able to evaluate economic pharmacy data
    • Able to write and orally communicate clinical and economic decisions to physicians and other health care personnel
    • Excellent communication skills, coordination and planning skills along with an ability to interact with a variety of audiences to build collaboration and consensus

    PM16

    Options

    Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
    Share on your newsfeed

    NOT READY TO APPLY?