Clinical Pharmacist-Medicaid
About The Position
Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn. Primary responsibility is to provide a superior level of service and act in a consultative manner to ensure the growth and retention of ACO membership and partners.
Requirements
- PharmD
- Current License to practice as pharmacist in Massachusetts without restriction
- Valid MA Driver’s License
- 5 years with at least one year in a managed care environment
- 1-2 years professional experience practicing as a clinical pharmacist
Responsibilities
- Provides clinical pharmacy support to Medicaid ACO and MCO members by:
- Identifying members for interactive consultation based on risk stratification or predictive modeling
- Performing medication reviews to identify medication related problems
- Performing interactive consultations and makes recommendations/interventions for members and providers, appropriately documents all pharmacotherapy interventions in internal case management tracking system
- Interacting with members telephonically or in person to review and reconcile medications
- Providing medication education telephonically or in-person to members
- Communicating trends identified from medication reviews to prescribers and/or clinical team members
- Receiving and responding to escalated calls regarding clinical or medication procurement issues
- Researching and resolving provider clinical inquiries in regards to medication and disease state management
- Designing and implementing targeted medication and disease management programs by analyzing medical and pharmacy utilization reports
- Designing and implementing targeted medication and disease management programs to ensure compliance with CMS and EOHHS requirements and regulations
- Providing in-service education related to medications, pharmacy or quality initiatives.. In-services may be designed for internal or external audiences including members.
- Assisting in implementation of new disease or medication management programs
- Coordinating with internal departments and external clients on disease and/or medication management projects.
- Reporting on clinical and financial outcomes of programs
- Providing pharmacy clinical services and programs designed to coordinate with community health center and community based pharmacies
- Provide required data and clinical reports for compliance and audits
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
