Managed Care Consultant Pharmacist IV - Remote

Managed Care Consultant Pharmacist IV - Remote

Job Number : 2025-48775

Category : Healthcare

Location : Westborough, MA

Shift : Day

Exempt / Non-Exempt : Exempt

Business Unit : ForHealth Consulting

Department : ForHealth Consulting - Pharmacy - W401453

Job Type : Full-Time

Num. Openings : 1

Post Date : Oct. 8, 2025

Work Location : 100% Remote

Salary Minimum : USD $105,000.00 / Yr.

Salary Maximum : USD $130,000.00 / Yr.

GENERAL SUMMARY OF POSITION :

Under the general direction of the Manager or Consultant Pharmacist Team Lead or designee, the Consultant Pharmacist IV functions as a team 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 in regards to prior authorization for member prescriptions and client members drug therapy. This position will participate in prospective and retrospective DUR activities including, but not limited to : handling live calls from physicians and pharmacists, reviewing appropriate drug therapy, coordinating and managing the request for prior authorization process, and participating in the development of clinical drug use criteria. This position will also be responsible for the orientation, training and indirect supervision of the Consultant Pharmacists and Pharmacy Associates.

MAJOR RESPONSIBILITIES :

• Provides orientation, training, guidance and direction, to Consultant Pharmacists and Pharmacy Associates
• Coordinates the request for prior authorization (RPA) process including the data entry and the generation of reports that stem from this process, as well as ensure compliance with the federal twenty-four hour time limit.
• Participates in program planning and development.
• Participates in the development of clinical drug use criteria for the prospective and retrospective review components of the DUR Program.
• Researches members case and may represent the client during appeal processes regarding prescription medications.
• Performs medication therapy management comprehensive and targeted medication reviews of medical and medication profiles
• Reviews members medical and medication profiles and interacts with health care providers and client members to review appropriate drug therapy.
• Provide real-time drug therapy recommendations to prescribers
• Reviews clinical documentation submitted by treating physicians and pharmacists to determine medical necessity and program compliance.
• Decides in real time via telephone communications with pharmacies the authorization or denial of prior approval requests for prescription medications.
• Provides pharmaceutical expertise and knowledge to the advisory boards clinical workgroups.
• Monitors over-utilization and under-utilization of prescribed medicines for members.
• Assists in monitoring and researching profiles for compliance on a daily basis.
• Refers suspected abuse and fraudulent members to the program manager or designee for case review.
• Participates in site visits to Provider offices, as necessary.
• Participates in agency meetings as requested.
• Leads and participates in quality improvement and quality assurance initiatives
• May perform other job related duties as assigned or requested.

REQUIRED QUALIFICATIONS :

PREFERRED QUALIFICATIONS :

Posting Disclaimer :

This job posting outlines the primary responsibilities and qualifications for the role but is not intended to be an exhaustive list. Duties and expectations may evolve in response to the needs of the department and the broader institution.

In alignment with our commitment to pay transparency, the base salary range for this position is listed above (exclusive of benefits and retirement). At UMass Chan Medical School, final base salary offers are determined based on a combination of factors, including your skills, education, and relevant experience. We also consider internal equity to ensure fair and consistent compensation across our teams.

Please note that the range provided reflects the full base salary range for this position. Offers are typically made within the midrange to allow for future growth and development within the role.

In addition to base pay, UMass Chan offers a comprehensive Total Rewards package, which includes paid time off, medical, dental, and vision coverage, and participation in a 401(a)-retirement plan, with the option to contribute to a voluntary 403(b) plan.

UMass Chan welcomes all qualified applicants and complies with all state and federal anti-discrimination laws.