Clinical Staff Pharmacist

Role Overview

• 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
• 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

Requirements

• Licensed Pharmacist required
• Bachelor’s Degree in Pharmacy required; PharmD preferred
• 5+ years of clinical pharmacy experience
• 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

Benefits

• medical
• vision
• dental
• well-being and behavioral health programs
• 401(k)
• company paid life insurance
• tuition reimbursement
• minimum of 18 days of paid time off per year
• paid holidays