Per Diem Clinical Pharmacist

Who We Are

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. Weve had a long-standing commitment to inclusion and equal healthcare access and outcomes regardless of background; its 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.

Job Summary

Job Description

Key Responsibilities/Duties what you will be doing (top five):

• Performs case reviews in automated prior authorization (Auto PA) tools and guides the case through the entire process to either approval or denial to ensure all coverage determinations and notices are consistent with applicable regulatory and accreditation requirements and turnaround times
• Provides all aspects of clinical support needed to perform drug prior authorization (PA) requests and consults as required with Medical Directors (MD) on cases that fail to meet coverage criteria
• 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
• Communicate with UM staff and providers when issues arise regarding policy interpretation potential access availability or other quality assurance issues to ensure that members receive coverage determinations within timelines developed by all accrediting and regulatory guidelines
• Facilitates communication between Pharmacy UM department and other internal departments by acting as a liaison or committee member on the development or implementation of new programs
• Performs other roles/duties and projects as assigned by the Pharmacy UM Supervisor or Director

Qualifications what you need to perform the job

Certification and Licensure

• Licensed to practice pharmacy with pharmacy degree required
• Current and valid pharmacist license

Education

• Required (minimum): Doctor of Pharmacy (PharmD)
• Preferred: PharmD from an ACPE-accredited school of pharmacy strongly desired

Experience

• Required (minimum): A minimum of 3 years full-time experience as a pharmacist preferably PBM and/or managed care setting.
• Preferred: 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 PAHub RxClaim and MedHOK 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.

Skill Requirements

• Strong interpersonal skills with ability to manage build relationships and influence member behavior
• Autonomous practitioner with strong critical thinking skills
• Articulate with ability to present clinical and administrative information concisely
• Independent problem-solving ability with ability to manage conflict and build consensus
• Organizational skills with ability to prioritize based on deliverable timelines member needs and contract requirements
• Ability to practice in an interdisciplinary team-based model

Working Conditions and Additional Requirements (include special requirements e.g. lifting travel):

• Travel to members residence and outside meetings
• Must be able to work under normal office conditions and work from home as required.
• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
• May be required to work additional hours beyond standard work schedule.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

Salary Range

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; the skills education training credentials and experience of the candidate; as well as internal equity. 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 andbenefits remains in the Companys sole discretion and maybe modified at the Companys sole discretion consistent with the law.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

• Medical dental and vision coverage

• Retirement plans

• Paid time off

• Employer-paid life and disability insurance with additional buy-up coverage options

• Tuition program

• Well-being benefits

• Full suite of benefits to support career development individual & family health and financial health

For more details on our total rewards programs visit welcome all
All applicants are welcome and will receive consideration for employment without regard to race color religion gender gender identity or expression sexual orientation national origin genetics disability age or veteran status.

Scam Alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact you may contact