Staff Pharmacist

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

3 Non-Negotiable Skills:
- Utilization Management Experience Preferred
- Strong clinical knowledge

- Able to make decision

• Licensed Pharmacist required
• Bachelor s Degree in Pharmacy required; PharmD preferred
• 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