Pharmacy Program Director in Boston, MA at Beacon Health Options

Date Posted: 12/2/2019

Job Snapshot

Job Description

About the Position:

Beacon Health Options is currently seeking a dynamic Pharmacy Program Director for out MassHealth account in Boston, MA! Working closely with MassHealth, the Pharmacy Program Director’s overall responsibility it to implement programs to optimize the state’s general pharmacy Medicaid program for those members receiving behavioral health services through MBHP.

The Director has regular meetings with the state to review progress made on monthly state required MBHP pharmacy programs, there is close coordination between the clinical and quality departments at MBHP and the pharmacy program in order to meet HEDIS and NCQA measures involving members’ use of psychotropic medications.

Position Responsibilities:

  • Pharmacy Quarterly, Monthly, and Weekly Reports to State
    • Consultations by MBHP pharmacist to MBHP clinical team
    • Frequency and details of MBHP pharmacist consults with case and care managers consults (both weekly and quarterly)
    • Frequency of state department of utilization review referrals for MBHP – weekly
    • Include number of consults, intervention types and outcomes
    • Identify positive outcomes and “challenge areas” for consults
    • # of eligible and ineligible consult referrals to MBHP pharmacist
    • Distinguish ACO from non-ACO referrals
    • Propose new initiatives
  • Controlled Substance Management Program (ICSMP) – quarterly report
    • List members with 11 or more controlled substance prescription fills within past 3 months
    • Letter sent to these member in program for a year of planned entry into program
    • Members have 60 days to appeal decision to state (state communicates w MBHP pharmacist on decision)
    • After 60 days, assign appropriate members to a unique pharmacy based on most frequent claims
    • Member’s notified of entry into program and the identified pharmacy
    • Note providers of these members
  • CVS/Walgreens program - quarterly
    • Send letter to CVS of members in CSMP for MBHP PCP and model A ACO members
    • Same for Walgreens
    • Summary list sent to State
  • Metabolic Screening Program – quarterly
    • Identify members with 2 antipsychotic medication fills of > 10 days in rolling 12 months
    • Use report #6348 to identify members
    • Alert prescribers (PCC’s or BH providers) of need for metabolic screening among members identified
  • Stable polypharmacy Mailing Initiative - monthly
    • Use pharmacy data (from state POPs system) to identify members on > 3 psychotropic medications for prior 3 months
    • Use report #5219
    • Send alert on these members to prescriber
  • Continued opioid use project
    • Identify opioid naïve members who have started opioid treatment for > ½ of last 60 days
    • Send member list to PCP
    • Evaluate opioid use between this group relative to controls

Position Requirements:

  • Education: PharmD required or MS degree with managed care pharmacy experience required
  • Relevant Work Experience: 2+ years of pharmacy experience in a health care company required, managed care or pharmacy benefit manager experience preferred
  • Travel: up to 10% local travel required within MA (no overnights)

To Apply:

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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled

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