Job Description:

Clinical Pharmacy Associate IIPay Rate: 20-27 per hourContract through end of 2024100% RemoteHigh School Diploma required or the equivalent combination of training and experience, plus 4 years of related experiencePharmacy Tech Certification required.Prior managed care or DUR experience a plusAbility to multitask in a fast-paced environment.The Clinical Pharmacy Associate II functions as a team member of the pharmacy department. Theresponsibilities focus on review of pharmacy requests for coverage determinationsexceptions within established timeframes as well as research and resolution of standard to complex pharmacy issues Principal Duties and Responsibilities: Indicate key areas of responsibility, major job duties, special projects and key objectives for this position. These items should be evaluated throughout the yea and included in the written annual evaluation.Maintain and update the Drug Look Up using the Formulary Navigator Program.Ensure criteria is accurate and posted in a timely manner.Review andor prepare all reconsideration and appeals requests prior to sending to a pharmacist or Medical Director for review.Review output of Pharmacy Associate I role to ensure quality and timely outcomes are maintained.Trouble-shoot and resolve mostly complex pharmacy rejections (Ex: copay issues, cost exceeds limitations, etc.) and advance only the most complicated issues.Perform, check, and audit of pharmacy claims to ensure Pharmacy Benefits Manager (PBM) data integrity and benefit coding.Collect, compile, and analyze pharmacy claims data to measure and report on performance of pharmacy programs (operations and clinical) for internal pharmacy management review and document trends.At the direction of and under the supervision of a Clinical Pharmacist, perform case reviews using automated prior authorization tools and guide the case through the entire process to ensure all coverage determinations are consistent with applicable regulatory and accreditation requirements and turnaround times.Maintain centralized Pharmacy SharePoint site, including timely upload of all pharmacy policies.Work on complex pharmacy projects.Serve as a pharmacy benefit guide for internal customers.Provide training to new pharmacy staff on system tools, as needed.Proactively identify and present process improvements to pharmacy management and team.Hold self and others accountable to meet commitments.Ensure diversity, equity, and inclusion are integrated as a guiding principle.Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.Other duties as assigned with or without accommodation.Qualifications: High School Diploma required or the equivalent combination of training and experience, plus 4 years of related experience.Pharmacy Tech Certification required.Associate degree preferred.Prior managed care or DUR experience a plus.