Staff Pharmacist
Job Description
Job Summary:
- Utilization management pharmacists are responsible for reviewing each plans policy to determine if coverage can be granted for a medication.
- Provide clinical support and oversight for all utilization management (UM) activities.
- Responsible for finalizing all denials of clinical prior authorization requests.
Required Skills:
- Supports the Coverage Review Department (CRD) as a clinical resource for drug therapy questions
- Applies critical thinking to achieve proper clinical decisions when performing clinical reviews
- Utilizes multiple systems and other clinical resources to achieve proper decisions in Utilization Management reviews
- Works and maneuvers within a queue system that prioritizes clinical reviews
- Makes clinical decisions quickly and at times decides and acts with limited information
- Works and collaborates with a multi-disciplinary clinical team to provide a customer centric experience
3 Non-Negotiable Skills:
- Utilization Management Experience Preferred.
- Strong clinical knowledge.
- Able to make decision.
Education & License Certification:
- Licensed Pharmacist required.
- Bachelor’s Degree in Pharmacy required; PharmD preferred.
- Proficient technical skills utilizing Microsoft Office applications required.
- Utilization Management Experience Preferred, but not required.
- Experience with Specialty Pharmacy/Pharmaceuticals preferred.
- 2+ years lead/supervisor or retail pharmacy experience preferred.