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Consultant Pharmacist Team Lead - REMOTE

Job Number: 2025-48131

Category: Healthcare

Location: Shrewsbury, MA

Shift: Day

Exempt/Non-Exempt: Exempt

Business Unit: ForHealth Consulting

Department: ForHealth Consulting - Pharmacy - W401453

Job Type: Full-Time

Salary Grade: P3

Num. Openings: 1

Post Date: May 19, 2025

GENERAL SUMMARY OF POSITION:

Under the general direction of the Associate Director or designee, the Consultant Pharmacist Team Lead functions as a team leader/member of the drug utilization review and medication management therapy programs within Clinical Pharmacy Services (CPS). CPS is responsible for administering client-specific programs to provide clinical expertise regarding prior authorization for member prescriptions and drug therapy. This position will participate in, and may oversee, prospective and retrospective DUR activities including handling live calls from physicians and pharmacists, reviewing drug therapy, coordinating prior authorization requests, developing clinical drug use criteria, and coordinating activities of clinical workgroups of program advisory boards. The position also involves orientation, training, and supervision of the Consultant Pharmacists and Pharmacy Associates.

MAJOR RESPONSIBILITIES:

• Provides orientation, training, guidance, and direction to Consultant Pharmacists and Pharmacy Associates.
• Prepares and coordinates client scheduled and ad hoc reports.
• Leads advisory board clinical workgroups: chairs meetings, recruits participants, gathers information, writes reports, analyzes data, and presents materials.
• Represents the program at client meetings, conferences, public forums, and informational meetings.
• Coordinates the request for prior authorization process, including data entry, report generation, and ensuring compliance with federal 24-hour time limit.
• Develops clinical drug use criteria for review components of the DUR Program.
• Researches member cases and may represent the client during appeal processes regarding prescriptions.
• Performs medication therapy management reviews of medical and medication profiles.
• Reviews profiles and interacts with healthcare providers and members to review drug therapy.
• Provides real-time drug therapy recommendations to prescribers.
• Reviews clinical documentation submitted by physicians and pharmacists for medical necessity and compliance.
• Decides on prior approval requests via telephone with pharmacies.
• Provides expertise to advisory boards clinical workgroups.
• Monitors medication utilization and compliance profiles.
• Refers suspected abuse or fraud cases for review.
• Participates in site visits to provider offices as needed.
• Engages in program planning, development, and quality improvement initiatives.
• Performs other related duties as assigned.

REQUIRED QUALIFICATIONS:

• Bachelor of Science in Pharmacy with 3 years of experience OR
• Doctor of Pharmacy with 2 years of pharmacy-related experience or completion of 2-year pharmacy residency OR
• Doctor of Pharmacy with 1-year residency and 1-year pharmacy experience

Eligibility for licensure or current pharmacist license in good standing in Massachusetts is required. Previous experience in medical/profile review and medication review, and ability to travel are also necessary.

PREFERRED QUALIFICATIONS:

• Bilingual fluency in English and another major language.

UMass Chan Medical School was among 23 companies recognized as 2023 DEI champions by The Boston Globe. It was also named a U.S. News & World Report 2023 BEST MEDICAL GRAD SCHOOL for Primary Care and Research.

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