Clinical Pharmacist

Company Overview

Point
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Health is a leading not‑for‑profit health and well‑being organization dedicated to delivering high‑quality, affordable healthcare. Serving nearly 2 million members, Point
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Health 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.

Under the direction of the Pharmacy Utilization Management (UM) Supervisor, the Clinical Pharmacist is responsible for reviewing, processing and managing the daily caseload of pharmacy prior authorization (PA) requests for coverage determinations (CD) and exceptions. The Clinical Pharmacist ensures timely disposition of reviews for CD and exceptions by adherence to established time frames. The Clinical Pharmacist consults as required with THP Medical Directors (MD) on prior authorization that fails to meet drug prior authorization (PA) criteria for coverage.

• Performs case reviews in automated prior authorization (Auto PA) tools and guides the case through the entire process to either approval or denial to ensure all coverage determinations and notices are consistent with applicable regulatory and accreditation requirements and turnaround times.
• Provides all aspects of clinical support needed to perform drug prior authorization (PA) requests and consults as required with THP Medical Directors (MD) on cases that fail to meet coverage criteria.
• Communicates daily with members, providers and other external customers regarding status and disposition of cases.
• Oversees and addresses any quality issues with pharmacy technicians and confers with other clinical pharmacists on review questions.
• Communicates with UM staff and providers when issues arise regarding policy interpretation, potential access availability or other quality assurance issues to ensure that members receive coverage determinations within timelines developed by all accrediting and regulatory guidelines.
• Facilitates communication between Pharmacy UM department and other internal Tufts Health Plan departments by acting as a liaison or committee member on the development or implementation of new programs.
• Performs other roles/duties and projects as assigned by the Pharmacy UM Supervisor or Manager.

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The annual base salary range for this position is determined by factors such as scope and complexity of the role, skills, education, training, credentials, and experience, as well as internal equity. Colleagues are also eligible for variable pay, and may receive bonus, commission, benefits, or other compensation subject to company discretion and law. Our total rewards package 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, visit Our benefits page.

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.

Point
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Health has recently become aware of job posting scams where unauthorized individuals posing as Point
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Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point
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Health 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 .