Pharmacist, Healthcare

Pharmacist - Utilization Management

Candidates will be reviewing members' Utilization Management (UM) requests (i.e., formulary exceptions, prior authorization, step therapy, quantity limit exceptions). Client-specific criteria are referenced to determine if a prior authorization can be approved or denied. The work is detail-oriented, and candidates will be expected to provide clinical judgement and communication.

• Responsible for the clinical evaluation for coverage determination requests for PA or other UM programs, including quantity limits, step therapy, formulary exception and tier exception, and includes consideration of the denial language and appropriateness of the decision as it pertains to the clinical content of the case and the intent of the individual client's pre-approved criteria

• Accountable for direct consultation with health care providers or members concerning non-formulary and clinical product coverage issues

• Collaborate with team members to promote consistency of decisions across the pharmacist team

• Other duties as assigned

Interaction level with Management/Team Members:

• Role is primarily independent with routine structured touchpoints.

• Regular communication with supervisors, senior pharmacists, technicians, and other team members via Teams messaging platforms, phone and video calls.

o Cameras/video calls used for:
Training sessions, Team meetings, routine 1:1s with supervisors.

• Senior Pharmacists are available throughout the day to support clinical questions and provide guidance.

Success Metrics

• Productivity:
Complete cases in an efficient manner consistent with the team average.

• Accuracy:
Achieve and maintain a quality score (error-free rate) of 95%.

• Accountability:
Demonstrate a strong attendance record and excellent communication skills.

• Team/culture fit:
Receptive to feedback, focus, problem-solving, accuracy, learning agility, sound clinical judgement, ability to work independently while still finding ways to collaborate with team-player attitude.

• Computer

Skills:

Quickly learn new systems; comfortable with multi monitor setups; adept at navigating multiple platforms, using available resources, Microsoft applications, and Auto Hotkey.

* All new pharmacists are considered as potential long-term employees with a hope to hire on as permanent employees in the future, but cannot guarantee a timeline on conversion and contracts are evaluated every 6 months for extension.*

Pharmacist, Retail, Clinical, Pharmacy Benefits Management, Pharmacy, Prior authorization, Pharmd, Compounding

Pharmacist,Retail,Clinical

Qualifications/years of experience:

• Doctor of Pharmacy (PharmD) or equivalent

• 6mo+ experience working in a retail environment

• Current pharmacist license in good standing with the State Board of Pharmacy in the State where the candidate is licensed.
* Verify by searching (State) State Board of Pharmacy, ex:
Oklahoma State Board of Pharmacy (will need license number from pharmacist). Also provide transparency on any disciplinary action taken on license which is provided in the search.

Prior PBM experience is NOT preferred.

Must Haves:

1. Ability to prioritize tasks and manage multiple projects simultaneously.

2. Drive to deliver results orientation.

3. A motivated self-starter who does not need constant direction or feedback to drive results.

4. Ability to make clinical decisions independently

5. Flexibility to change and resourceful

Technology Requirements:

• Proficient with learning new computer systems, basic IT trouble shooting and using multiple monitors

• Word and Excel

• Ability to type 45+ WPM

Job Type & Location

This is a Contract to Hire position based out of Eagan, MN.

Pay and Benefits

The pay range for this position is $55.00 - $55.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions…