Utilization Management Pharmacist
J
Judi HealthHealth Technology
RemoteContractMiddle
Salary125,000 - 130,000 USD per year
Apply NowOpens the employer's application page
Job Details
- Experience
- Minimum of 6 months to a year of prior authorization or utilization management experience; Minimum of 2 years of pharmacy practice experience
- Required Skills
- HIPAA
Requirements
- Active, unrestricted pharmacist license.
- Bachelor’s or Doctor of Pharmacy degree.
- Minimum of 6 months to a year of prior authorization or utilization management experience.
- Minimum of 2 years of pharmacy practice experience.
- Experience in managed care or pharmacy benefit management (PBM).
- Availability to work after hours, weekends, and holidays on a rotating schedule.
- Strong communication, writing, and organizational skills.
- Ability to manage multiple priorities in a high-volume, metric-driven environment.
- Call center experience preferred.
Responsibilities
- Review and make timely, evidence-based decisions on prior authorizations, appeals, and override requests.
- Ensure compliance with federal, state, and internal regulations across Commercial, Exchange, Medicare, and Medicaid plans.
- Document clinical decisions accurately in accordance with URAC/NCQA standards.
- Provide clinical support to members, prescribers, and pharmacies via phone.
- Stay current with clinical prescribing guidelines and regulatory changes.
- Identify and report potential fraud, waste, and abuse.
- Support training and development of team members as needed.
- Assist with special projects and process improvements.
View Full Description & ApplyYou'll be redirected to the employer's site
