Pharmacist - Utilization Management; UM Remote
Position: Pharmacist - Utilization Management (UM) Remote
JOB SUMMARY
This role reviews medication coverage determinations for prior authorization requests and appeals. The incumbent evaluates clinical information against medical policy criteria using the Utilization Review system, then makes coverage determinations and routes claims appropriately.
ESSENTIAL RESPONSIBILITIES
• Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records to ensure claims are routed and paid.
• Conduct research beyond medical policy review to decide on medication coverage requests.
• Other duties as assigned.
EDUCATION
• Bachelor's degree in Pharmacy
EXPERIENCE
• 1 - 3 years in Pharmacy
LICENSES OR CERTIFICATIONS
• Registered Pharmacist
SKILLS
• Oral & Written Communication Skills
• General Computer Skills
• Problem Solving & Decision Making
• Compliance
• Prioritizing
Language Requirement
None
Travel Required
None
Pay Range Minimum
$67,500.00
Pay Range Maximum
$
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
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Apply Now
Apply Now
JOB SUMMARY
This role reviews medication coverage determinations for prior authorization requests and appeals. The incumbent evaluates clinical information against medical policy criteria using the Utilization Review system, then makes coverage determinations and routes claims appropriately.
ESSENTIAL RESPONSIBILITIES
• Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records to ensure claims are routed and paid.
• Conduct research beyond medical policy review to decide on medication coverage requests.
• Other duties as assigned.
EDUCATION
• Bachelor's degree in Pharmacy
EXPERIENCE
• 1 - 3 years in Pharmacy
LICENSES OR CERTIFICATIONS
• Registered Pharmacist
SKILLS
• Oral & Written Communication Skills
• General Computer Skills
• Problem Solving & Decision Making
• Compliance
• Prioritizing
Language Requirement
None
Travel Required
None
Pay Range Minimum
$67,500.00
Pay Range Maximum
$
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
#J-18808-Ljbffr
Apply Now
Apply Now