Lead Utilization Management Pharmacist
New
J
Judi HealthPharmacy benefits
Remote, US Salary Range, 2p-11p ET shiftFull-TimeLead
Salary134,000 - 146,000 USD per year
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Job Details
- Experience
- 2+ years of pharmacy practice experience
- Required Skills
- MS OfficeCustomer service
Requirements
- Hold an active, unrestricted pharmacist license.
- Have a Bachelor's or Doctor of Pharmacy Degree.
- Have 2+ years of pharmacy practice experience.
- Have experience in customer service, call center work, and prior authorization.
- Have working knowledge of MS Office.
- Be able to work the 2p-11p ET shift and participate in weekend and holiday rotation.
- Maintain a designated workspace with a closed door that is visibly secure from others and protected from disruptive noise.
- Have wired DSL, cable modem, or fiber internet; Wi-Fi is not allowed, and the posting specifies internet speed of one gigabyte (940bps).
- Be able to work independently in a remote, high-volume, metric-driven call center environment.
- Be able to manage competing priorities and collaborate with a team.
Responsibilities
- Perform and oversee prior authorization and appeal reviews, override requests, and inbound and outbound member and provider education calls.
- Support the training and development of staff and provide guidance on best practices for clinical pharmacy services.
- Contribute to quality improvement initiatives and lead projects to improve pharmacy operations, member care, and clinical outcomes.
- Collaborate with business, clinical, compliance, and quality assurance partners to improve workflows and identify risk mitigation strategies.
- Serve as a subject matter expert on clinical medication reviews and provide consultation to the pharmacy team, providers, and other stakeholders.
- Monitor review queues for regulatory and internal compliance and ensure timely, accurate processing of clinical reviews.
- Make clinical decisions using medical necessity and contract criteria, supported by scientific literature and drug resources.
- Review pharmacy claims data to identify opportunities for proactive outreach and intervention and monitor inappropriate care trends.
- Maintain quality, productivity, and turnaround-time standards and provide backup support to the call center as required.
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