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.
• Utilization Management Experience Preferred.
• Strong clinical knowledge.

Preferred Skills:

• 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.