Job Specification
PHARMACEUTICAL CONSULTANT
DEFINITION:
Under the direction of a Medical Consultant, Chief Pharmaceutical Services or
other supervisory official, as a licensed Pharmacist, is responsible for provision
of pharmaceutical consultative services required to implement the pharmaceutical
services aspects of all department programs including Medicare, Medicaid, and
PAAD programs; ensures pharmaceutical services provided by the department
meet all applicable regulatory and legal requirements as set forth by State and
federal agencies; does other related duties as required.
NOTE: The examples of work for this title are for illustrative purposes only.
A particular position using this title may not perform all duties listed in this
job specification. Conversely, all duties performed on the job may not be
listed.
EXAMPLES OF WORK:
Provides professional pharmaceutical consultant services and oversight of
the pharmaceutical services aspect of the health services program in the
region or area designated by the department.
Develops appropriate provider communications through newsletters, alerts,
and remittance advice messages, as they apply to the administration of
policies and procedures related to department pharmaceutical services.
Confers with pharmacists and providers of medical supplies and equipment
relative to interpretation of the program.
Provides consultation to staff and providers regarding medical supplies and
durable medical equipment.
Refers items requiring prior approval, authorization, or review which cannot
be acted on locally due to possible conflict of interest to the district office
director or designee to arrange for a final disposition.
Provides consultation to professional and clerical staff assigned to assist with
utilization review as auditing of pharmaceutical services furnished by eligible
recipients.
Identifies and maintains a roster of local medical-surgical supplies for use by
eligible recipients.
Reviews financial analyses performed by the contracted agent for the
maintenance of financial projections and rate setting for the NJ Medicaid
program.
Establishes and maintains liaison and interprets the pharmaceutical services
aspect of the Medicaid program to staff of the Medicaid District Offices, staff
of the County Welfare Boards or agencies, and staff of district offices of the
Department of Children and Families; provides consultation and advice
accordingly.
Establishes and maintains liaison and interprets the pharmaceutical services
aspect of the Medicare Part D program to staff of the County Offices on Aging;
provides consultation and advice accordingly.
Reviews Managed Care Organization (MCO) formulary updates and
pharmacy-related contractual issues regarding beneficiary access to
pharmaceutical benefits.
Assists beneficiaries and pharmacy providers with the coordination of
benefits between Medicare Part D, Third Party Liability, Medicaid, and
other state/federal programs; assesses Medicare Part D formulary
limitations to maximize coordination of benefits for beneficiaries.
Collaborates in the development of State Plan Amendments and submits
required annual reporting for the Centers for Medicare and Medicaid
Services (CMS).
Confers with pharmacists and peer review committees of local Pharmaceutical
Associations regarding all aspects of the pharmaceutical services program and
participates in evaluating questionable practices, complaints of pharmacists
and/or recipients, or unusual cases.
Oversees the NJ Drug Utilization Review Board (DURB), its protocols, and
standards for the State’s claims processing system for pharmaceutical services.
Performs activities in accordance with department/division policies and
procedures to promote effective monitoring and control of appropriate utilization
of pharmaceutical services; collaborates with the department, state auditors, and
state/federal fraud divisions to provide information and reports.
Participates with department/division staff in the further development, analysis,
and evaluation of policies, procedures, and methods of providing pharmaceutical
and health services to recipients; responds to legislative proposals containing
pharmaceutical-related issues for the State.
Continuously reviews the quality and quantity of pharmaceutical services
provided to Medicaid recipients and others who receive department services by
evaluation of printouts or profiles of recipients, pharmacists, and/or prescriptions
to determine evidence of abuse, overuse, and/or appropriateness of services;
conducts onsite inspections of prescriptions, invoice costs of pharmaceuticals,
medical supplies, and equipment to determine adherence to price or costing
provisions of the Health Services Program.
Recommends to the pertinent department/division official suggested changes
in policies and procedures based on local operational experiences.
Serves as subject matter expert (SME) for all state and federal pharmaceutical
assistance programs, including but not limited to Medicare Part D,
Pharmaceutical Assistance to the Aged and Disabled (PADD), and Medicaid;
serves as the state SME and liaison for the development, modification, and/or
replacement of management information systems for Medicaid, PADD, and
other pharmaceutical programs.
Participates in training programs for staff members of the department/division
concerning the pharmaceutical services aspect of the Medicaid Program and
other programs administered by the department and its agencies.
Participates in appeal hearings concerning pharmaceutical providers as well
as recipients.
Will be required to learn how to utilize various types of electronic and/or manual
recording and information systems used by the agency, office, or related units.
REQUIREMENTS:
EDUCATION:
Graduation from an accredited college, university, or School of Pharmacy with
a Doctor of Pharmacy degree.
EXPERIENCE:
Four (4) years of experience as a Registered Pharmacist which shall have
included two (2) years of experience with a large public health program,
health carrier, hospital, and/or retail pharmacy.
LICENSE:
Possession of a valid license as a Registered Pharmacist issued by the
State of New Jersey.
Appointees will be required to possess a driver's license valid in New Jersey
only if the operation of a vehicle, rather than employee mobility, is necessary
to perform the essential duties of the position.
KNOWLEDGE AND ABILITIES:
Knowledge of pharmaceutical practices and procedures.
Ability to organize assigned work, analyze pharmaceutical and related
problems, and develop effective work methods.
Ability to work as a member of a team designed to improve pharmaceutical
services provided to welfare recipients and the medically needy in the state.
Ability to understand and interpret established pharmaceutical procedures
in relation to specific cases.
Ability to provide technical assistance to department staff.
Ability to establish and maintain liaison between department facilities including
district offices and local Pharmaceutical Society or societies and the staff of
County Welfare Boards or agencies.
Ability to conduct conferences with peer review and other committees.
Ability to effectively monitor and control appropriate utilization of
pharmaceutical and health services to recipients.
Ability to conduct onsite inspections of prescriptions and medical supplies
and equipment.
Ability to make recommendations to pertinent department/division officials.
Ability to participate in training programs for staff members.
Ability to maintain essential records and files.
Ability to learn how to utilize various types of electronic and/or manual
recording and information systems used by the agency, office, or related
units.
Ability to read, write, speak, understand, and communicate in English
sufficiently to perform the duties of this position. American Sign Language
or Braille may also be considered as acceptable forms of communication.
Persons with mental or physical disabilities are eligible if they can perform
the essential functions of the job with or without reasonable accommodation.
If the accommodation cannot be made because it would cause the employer
undue hardship, such persons may not be eligible.
This job specification is applicable to the following title code: | | Job
Spec
Code | Variant | State,
Local or
Common | Class of
Service | Work
Week | State
Class
Code | Local
Class
Code | Salary
Range | Note | | 01296 | | S | N | NL | 28 | N/A | P28 | - |
This job specification is for state government use only.
Salary range is only applicable to state government.
Local salaries are established by individual local jurisdictions.
7/30/2022 |
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