Clinical Utilization Management 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. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s 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):

• Provides subject matter expertise for the integrated team and supports the member’s medication management needs
  • Provides clinical pharmacy services and support to members and providers
  • Manages members with complex pharmaceutical needs in collaboration with the care team
  • Completes medication review and reconciliation for members with complex medication regimen
  • Serves as the medication expert for patients, providers, and care team members
  • Works closely with other members of the care team, members’ family, and caregivers
  • Collaborates with care team in care management, coordination of care and care planning in the transitions of care
  • Works closely with other members of the care team, members’ family, and caregivers
  • Documents appropriately and timely in the care management information system
  • Participates in risk management activities, including identifying and communicating issues of risk in a timely manner
  • Participates in case reviews and care team huddles
  • Serves as a liaison between members, providers, and medication management service providers
• Provides administrative support and plays a key role in performance management
  • Collects and analyzes related data, as needed.
  • Participates in risk management activities, including identifying and communicating issues of risk in a timely manner
  • Adheres to departmental/organizational policies and procedures
  • Complies with established metrics for performance, adheres to documentation and workflow standards
  • Maintains HIPPA standards and confidentiality of protected health information
  • Represents Point32Health in a professional manner and participates in the ongoing development and growth of the department and overall organization
• Perform other duties and projects as assigned.

Qualifications – what you need to perform the job

Certification and Licensure

• Licensed to practice pharmacy in Massachusetts with pharmacy degree required
• Current and valid Massachusetts pharmacist license
• Certification by the Board of Pharmacy Specialties in a relevant area of pharmacy practice (e.g., BCACP, BCGP, BCPP, BCPS).

Education

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

Experience

• Required (minimum): 5 or greater years of progressive clinical pharmacy experience in managed care, facility, and retail setting. 2 years of related clinical experience in an ambulatory setting. Extensive knowledge of Medicare and MassHealth formularies. Care management, high-risk population, and/or transitions of care experience
• Preferred:

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 and benefits remains in the Company's sole discretion and may be modified at the Company’s 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 https://www.point32health.org/careers/benefits/

We 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 TA_operations@point32health.org