Description

You will support all lines of business by reviewing utilization management requests for clinical appropriateness and cost-effectiveness. You'll work with pharmacy technicians, pharmacists, and medical directors to ensure compliant and timely case reviews, and you'll help develop clinical policies and programs like prior authorization and step therapy.

Requirements

• Pharmacy Degree required, PharmD preferred
• 1 year experience coordinating medication selection with prescribers
• Managed care prior authorization experience preferred (1-3+ years)
• Active pharmacist license in state of residence, willingness to obtain multi-state licensure
• Available to work 40 hours/week within 8am-8pm ET, occasional evening/weekend shifts and on-call every ~2 months

Responsibilities

• Review utilization management requests for clinical appropriateness and cost-effectiveness
• Ensure UM operational processes are effective and compliant with state and federal guidelines
• Coordinate with pharmacy technicians, pharmacists, and medical directors on UM activities
• Participate in quality review and inter-rater reliability processes
• Develop clinical policies and UM programs (prior authorization, step therapy, etc.)