Clinical Pharmacist Utilization Management
About The Position
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Unique opportunity for a clinical pharmacist to improve patient care and outcomes through completion of utilization management functions for value-based patients in the Optum West region. Under general supervision of the Pharmacy Manager, the Clinical Pharmacist is responsible for evaluating medication utilization and prior authorization requests for specialty oncology and non-oncology ambulatory injectable and/or infusion medications as related to member benefits, medical necessity, site of service, and evidence based clinical guidelines.
Requirements
- Doctor of Pharmacy degree (PharmD)
- Current unrestricted Pharmacist license to practice in CA
- 3+ years of experience as a Prior Authorization Pharmacist or Clinical Pharmacist, conducting such activities as medication therapy management, clinical rounds, disease state management
- Experience working in a metric-driven environment
- Proven excellent written and verbal communication skills
- Proven excellent relationship building skills
- Proven solid analytical and PC operation skills
- Proficiency in Microsoft Office Tools (Outlook, One Note, Teams, Word, Excel, etc)
- Access to High-Speed Internet and a designated, distraction free workplace
Nice To Haves
- Board certification by the Board of Pharmacy Specialties (BPS)
- Pharmacy Benefit Management
- Certified Geriatric Pharmacist
- 1+ years of experience in Oncology Setting
- Proven knowledge of Medicare, Medicaid, and commercial payor guidelines
- Demonstrated planning and organizational skills to demonstrate leadership and initiative
Responsibilities
- Completes assigned daily prior authorization case reviews to meet production and performance metrics as determined by the department to maintain compliant timeliness standards
- Review specialty medication prior authorization requests according to established treatment protocols, clinical criteria/guidelines, regulatory requirements and member benefits to ensure consistent and accurate application of clinical criteria & the determination is made within the defined processing times to meet regulatory requirements
- Knowledgeable of current and emerging clinical trends
- Provide internal and external clinical pharmacy subject matter consultation to members, physicians, prescribers, nurses, and pharmacists
- Proactively identify process improvement opportunities and collaborate with other teams and leaders
- Assist with user acceptance testing for new clinical programs and system enhancements
- Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practice specific to specialty pharmacy
- Research and awareness about drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
- Follow all policies and procedures, SOPs related to the job
- Performs all other related duties/activities as assigned to meet departmental objectives
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
