Pharmacist - Utilization Management; UM - Remote

Job Summary

This job reviews requests for medication coverage determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by the physician against medical policy criteria. The incumbent then uses his/her clinical knowledge compared to the policy and physician request to make a determination. At times, the incumbent may conduct additional research beyond medical policy review to make coverage determinations.

• Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure claims are properly routed and paid.
• Conduct research beyond medical policy review to make decisions on medication coverage requests.
• Other duties as assigned.

Required

• Bachelor's degree in Pharmacy

Preferred

• Doctorate degree in Pharmacy

• None

Required

• 1 - 3 years in Pharmacy

Preferred

• None

Required

• Registered Pharmacist

Preferred

• None

• Oral & Written Communication Skills
• General Computer Skills
• Problem Solving & Decision Making
• Compliance
• Prioritizing

None

None

• Position Type:
  Office-Based
• Teaches / trains others regularly:
  Occasionally
• Travel regularly from the office to various work sites or from site-to-site:
  Rarely
• Works primarily out-of-the office selling products/services (sales employees):
  Never
• Physical work site required:
  Yes
• Lifting: up to 10 pounds:
  Constantly
• Lifting: 10 to 25 pounds:
  Rarely
• Lifting: 25 to 50 pounds:
  Rarely

Pay Range Minimum: $67,500.00

Pay Range Maximum: $

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