Manage the Planís pharmacy benefits to include, but not be limited to: formulary design,
development, implementation and risk management.
Review member, physician, pharmacy and drug utilization reports. Identify and communicate
emerging trends affecting the pharmacy benefits in an MCO environment.
Manage the annual evaluation and reprocurement of pharmacy vendors,
Responsible for negotiating prices and services as necessary
Assist with prior authorization for medication requests. Maintain and update criteria for
review, and participate in the prior authorization decision-making process as needed.
Implement and monitor specific outcome studies as a component of disease state management
Identify opportunities and support projects/activities with external organizations (DMAA,
NCQA, DSM vendors, professional orgs).
Communicate account / project activities, and status updates to core department entities and
Hire, orient and provide supervision, performance evaluation and professional development to
all pharmacy staff and intern(s).
Education and Experience:
Bachelorís degree in Pharmacy required, PharmD preferred.
Current unrestricted licensure as a pharmacist in the Commonwealth of Massachusetts or, the
ability to obtain unrestricted licensure within a reasonable period of time, is required.
A minimum of five (5) to ten (10) years managed care pharmacy experience is required.
Experience or in-depth knowledge of disease management programs including outcomes programs
and their implementation at MCO/provider level, Case Management and Phase II-IV clinical
Competencies and Attributes:
Excellent written and verbal communication skills.
Comprehensive knowledge of accrediting organizations such as NCQA.
Comprehensive knowledge of InterQual protocols, HEDIS, Case Management and other quality
Training/experience in economics/econometrics, cost benefit/analysis, Quality of Life and
other studies and their application to drug therapy.
Knowledge of federal Medicaid and MassHealth regulations, guidelines, and standards.
Proven negotiation skills, relationship building and knowledge of risk concepts.
Familiarity with FACETS database desired.
Expertise utilizing Microsoft Office products.