About us:

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

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.

Primary Job Responsibilities: 

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 makes 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

• PharmD

License/Certifications: 

• Current License to practice as pharmacist in Massachusetts without restriction
• Valid MA Driver’s License 

Experience: 

• 5 years with at least one year in a managed care environment
• 1-2 years professional experience practicing as a clinical pharmacist

Pay Range Disclosure:
In accordance with the Massachusetts Wage Transparency Act, the pay for this position is $  135,000-$145,000 annually which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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