Reporting to the Manager of Pharmacy Services, Medicare, the Medicare Clinical Pharmacist II is primarily responsible for supporting the Medicare Part D clinical programs and daily operations. In addition the Medicare Clinical Pharmacist II will support resolution of member/provider inquiries, utilization management reviews, clinical program design and implementation, and Medicare formulary management. The Medicare Clinical Pharmacist II will interface with members, physicians, nurses, internal employees, and PBM representatives.

Key Functions/Responsibilities:

• Maintain knowledge on all CMS regulations as they pertain to Medicare Part D and Medicare Part B medications
• Provide clinical oversight of daily operations for the Medicare Pharmacy Specialist, including responding to member and provider inquiries and utilization management activities as required
• Work in conjunction with the Manager of Pharmacy Services, Medicare on quality improvement activities and initiatives, including STARs and those that support requirements to meet CMS Medicare Part D standards and other state and federal regulations and contracts
• Execute clinical quality programs including initiatives related to STARs measures
• Conduct adherence outreach and interventions to meet organizational STARs measure goals
• Perform MTM Comprehensive Medication Reviews in accordance with all quality and CMS program standards to achieve organization completion rate goals
• Collaborate with the applicable Care Management teams to provide pharmacy support in identifying, resolving and preventing medication related problems. May include direct outreach and performing one-on-one consultations with high risk members and providers
• Administer the Plan’s clinical pharmacy programs which include medication assessments to address indications, effectiveness, safety and adherence
• Key participant on clinical and quality initiatives that address industry and regulatory health-related issues
• Identify areas of potential cost-saving and quality improvement initiatives in collaboration with the PBM and/or internal departments
• Participate on clinical committees as necessary
• Assist Manager of Pharmacy Services, Medicare with oversight of PBM
• Communicate effectively with internal and external constituents (physicians, pharmacies, etc.) regarding the Medicare pharmacy program and processes

Qualifications:

Education:

• Bachelor of Science in Pharmacy

Preferred/Desirable:

• Doctor of Pharmacy
• Residency training
• Commission for Certification in Geriatric Pharmacy (CCGP) or Board of Pharmaceutical Specialties (BPS) certification in Geriatrics
• Board of Pharmaceutical Specialties (BPS) certification in Pharmacotherapy

Experience:

• 3+ years clinical experience or completion of an accredited residency program
• 1+ years of prior experience with Medicare Part D

Preferred/Desirable:

• 1+ years of prior managed care experience
• Providing drug therapy recommendations to prescribers

Certification or Conditions of Employment:

• Pre-employment background check
• Valid unrestricted licensure as a pharmacist in the United States required
• Pharmacist licensed in Massachusetts and/or New Hampshire preferred

Competencies, Skills, and Attributes:

• Extensive knowledge of drug products, medical therapeutics, pharmacokinetics, and disease states
• Proficient in Microsoft Office applications, particularly MS Outlook, MS Word, MS PowerPoint, and MS Excel
• Strong oral and written communication skills
• Ability to interact with multiple levels of internal employees and external contacts including prescribers
• Able to work in fast paced environment
• Strong analytical and clinical problem solving skills
• Detail-oriented and able to manage multiple priorities
• Ability to review & analyze data

Working Conditions and Physical Effort:

• Occasional travel (<5%) may be required
• Light on-call coverage
• Regular and reliable attendance.
• Fast paced office environment

• Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.