Pharmacist - Utilization Management (UM) - Remote

Overview

This job involves reviewing requests for medication coverage determination for prior authorization review and appeals, using clinical knowledge to evaluate information against medical policy criteria.

In Short

• Evaluate physician requests for medication coverage.
• Make coverage determinations based on medical policy.
• Conduct additional research for decision-making.
• Update system records for claims processing.
• Communicate effectively with stakeholders.
• Adhere to legal and ethical standards.
• Work primarily from home.
• Maintain compliance with HIPAA and company policies.
• Required education includes a Bachelor's or Doctorate in Pharmacy.
• 1-3 years of pharmacy experience is required.

Requirements

• Bachelor's degree in Pharmacy required.
• 1-3 years of experience in Pharmacy required.
• Registered Pharmacist certification required.
• Strong oral and written communication skills.
• General computer skills.
• Problem-solving and decision-making abilities.
• Ability to prioritize tasks effectively.
• No travel required.

Benefits

• Competitive salary range from $67,500 to $126,000.
• Opportunities for professional growth.
• Work from home flexibility.
• Comprehensive health benefits.
• Supportive work environment.
• Access to company resources and training.