Clinical UM Pharmacist

The Clinical UM Pharmacist is a dynamic position responsible for the review of prior authorizations for medications requested under the medical benefit. Additionally, the Clinical UM Pharmacist is responsible for developing clinical criteria, medical policies for provider administered medications, review of monthly report for quality assurance, and staying current with literature, evidence-based medicine, and trends in medicine. The Clinical Pharmacist works directly with prescribing physicians and Medical Directors to discuss clinical rationale for review decisions.

• Monitor and review prior authorization requests for medications
• Calculate appropriate billable units based on dosing, indication, weight, BMI and other clinical considerations
• Develop clinical criteria and medical policies for the review of medications
• Ensure all clinical criteria is in compliance with Center of Medicare and Medicaid Services (CMS) and the New York State Department of Health (NYSDOH)
• Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
• Ensure prior authorization reviews are conducted in time frames set forth by CMS and/or NYSDOH
• Work across departments as needed to complete Utilization Management reviews
• Review monthly reports and provide feedback on trends, ideas for efficiency, and innovation
• Ability to work well in a team environment and be a team player
• Additional duties as assigned or required

• Pharmacy degree from an accredited school of pharmacy
• Registered Pharmacist with a state license in good standing.
• Work experience conducting prior authorization reviews
• Clinical knowledge of pharmaceuticals and disease states in order to conduct prior authorization reviews
• Work experience requiring written and verbal clinical communication that is clear, concise, grammatically correct, and professional
• Knowledge of specialty pharmaceuticals and billing practices in the medical and pharmacy benefits

• PGY1 Managed Care Residency
• Knowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to National and Local Coverage Determinations
• Demonstrated critical thinking and problem-solving skills
• Passion for learning, promoting the profession of pharmacy, and interest in growing skills in a dynamic environment with various opportunities
• Experience leading large and small working meetings
• PC Skills with Microsoft Outlook, Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables)

Assists in regulatory and compliance audits for all plans. Ensure all activities are conducted in compliance with regulations.

Licensed pharmacist in good standing

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status or unemployment status, as well as any other legally protected basis.

HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers or calling . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying.

Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a…