Cambridge MA 02141 58 Charles Street
Job DescriptionThe Operations Pharmacist oversees the pharmacy coverage determination requests (first level reviews) processes, and appeals and grievances processes, as well as all other operations in the pharmacy department. The pharmacist works collaboratively with other departments and external providers to ensure member needs are being supported, as well as supporting day to day operations. The pharmacist also assists the pharmacy leaders in ensuring compliance with all federal, state and accreditation requirements.
Supports the pharmacy technicians with coverage determinations, appeals and grievances, including support clinical functions and compliance with CMS requirements; medical necessity decisions and any denials.
Discusses clinical information related to drug therapy with physicians and other prescribers.
• Collaborates on gathering medical necessity documentation and submission of appeals to the health plan medical directors
• Provides the primary support for the clinical services, client services and any other department as it relates pharmacy.
• Provides education and training to health plan staff on pharmacy operations and ongoing projects.
• Collaborates with PBM partner to resolve member, provider and departmental issues as necessary.
• Understands and manages pharmacy benefit issues in compliance with federal, state, and NCQA accreditation requirements
• Analyzes results from standard and ad hoc reports in an effort to improve clinical and administrative operations.
* Provides oversight of daily activities of pharmacy technicians and interns in support of Clinical Pharmacy Manager.
• Takes call on nights and weekends, in rotation with other staff.
General Job Information
Job FamilyPharmacy Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date7/22/2019
Date Requisition Created7/22/2019
EducationBachelors: Pharmacy (Required)
License and Certifications - RequiredRPH - Registered Pharmacist - Pharmacy
License and Certifications - PreferredPharmD - Doctor Of Pharmacy, State Licensure - Pharmacy
Other Job Requirements
• Pharmacy experience required with experience with senior populations preferred
• Utilization Management and Part D coverage determination experience preferred
• Managed Care, Medicare part D and Managed Medicaid experience preferred
• BS Pharmacy
Minimum of one year experience in Pharmacy
• Excellent written and verbal communication skills
• Ability to interact with individuals on all levels
• Self directed, self motivated, able to work independently and to direct others.
• Attention to detail.
• Strong time management skills and the ability to meet deadlines and time commitments.
• Able to work in Microsoft Word, Excel, PowerPoint, etc
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.
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