Clinical UM Pharmacist Job Seattle area,Washington USA,Healthcare

The Clinical Pharmacist is a dynamic position responsible for the review of prior authorization requests for medications requested under the medical benefit. Additionally, the Clinical Pharmacist will be 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 will work directly with prescribing physicians and Medical Directors to discuss clinical rationale for review decisions.

This position reports to the Sr. Pharmacy Manager

Duties & Responsibilities:

Monitor and review prior authorization requests for medications
Calculate appropriate billable units based on dosing based, 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
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

Minimum Qualifications:

Pharmacy degree from an accredited school of pharmacy
Registered Pharmacist in the state of New York with a license in good standing.
Minimum of 1 year experience conducting prior authorization reviews
Strong clinical knowledge of pharmaceuticals and disease states in order to conduct prior authorization reviews
Strong clinical writing and verbal skills
Demonstrated critical thinking and problem-solving skills.
Knowledge of specialty pharmaceuticals and billing practices in the medical and pharmacy benefits
Passion for learning, promoting the profession of pharmacy, and interest in growing skills in a dynamic environment with various opportunities

Preferred Qualifications:

PGY1 Managed Care Residency (optional)
Knowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to National and Local Coverage Determinations.
Ability to lead large and small working meetings.
PC Skills with Microsoft Outlook, Word, PowerPoint (creating presentations and slides), and Excel (Pivot tables).

License or Certification :
Licensed pharmacist in the state of NY in good standing.

Regulatory or Compliance activities:

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

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…