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Location: Shrewsbury, MA
Business Unit: Commonwealth Medicine
Department: Commonwealth Medicine - Disability Evaluation Services - W401800
Salary Grade: 50
Num. Openings: 1
Post Date: Jan. 11, 2019
GENERAL SUMMARY OF POSITION:
The Drug Utilization Review Program is responsible for administering a statewide program for the Division of Medical Assistance to provide clinical expertise in regards to prospective DUR and retrospective DUR for MassHealth member prescriptions. This position is responsible for assisting DUR in all clinical aspects of the program. Working with the Medical Director, the Physician Advisor will provide clinical guidance in education, training and development to management and clinical teams at DUR.
- Assist in clinical guideline development for drugs that require prior authorization.
- Evaluate results of therapeutic class reviews for the MassHealth Drug List and make recommendations.
- Review, research and advise the DUR Program on new to market drugs.
- Intervene with physician consults on difficult prior authorization requests and member profile review.
- Advise the DUR Program on formulary development.
- Work with the DUR Retrospective Project team on the design of DUR retrospective projects and disease state management.
- Contribute to quality improvement initiatives developed within the Drug Utilization Review Program.
- Travel to off-site locations is required
- Activities, procedures and decisions are varied in nature, requiring independent action and judgment in solving both commonly encountered and unusual problems.
- The analytical skills include evaluating and developing alternatives to address problems and issues.
SPECIAL SKILLS AND COMPETENCIES:
- Oral and interpersonal communication skills required including:
- Providing information to others in a clear an understandable manner.
- Receiving and understanding information provided by others.
- Explaining alternatives, recommending solutions and/or persuading others towards a course of action usually related to commonly encountered problems.
- Medical Doctor
- Board eligible or certified in area of specialty and have had experience in direct patient care.
- Proficiency in Office Applications
Experience with MassHealth or Medicaid is preferred.
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