Clinical Pharmacy Coordinator (Pharmacist) - Per Diem

UHS•Reno, NV

78d•Remote

About The Position

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience. Learn more at: https://prominence-health.com/ Job Summary: The Clinical Pharmacy Coordinator executes clinical programs related to utilization management, care management, and quality improvement. To do this, this position will have knowledge of pharmaceutical services provided under both the pharmacy and medical benefits. The Clinical Pharmacist Coordinator will be responsible for pharmaceutical service request reviews and render determinations of medical necessity and appropriateness of request. The Clinical Pharmacy Coordinator holds an active, unrestricted license or certification to practice pharmacology medicine in a state or territory of the United States. They are qualified to render appeal determinations in addition to initial determinations and non-certifications. The Clinical Pharmacy Coordinator Reviewers have access to consult with initial clinical reviewers, other medical advisors, licensed doctors, or peer reviewers through several modes of contact. The position will regularly interface with the pharmacy benefits manager, pharmacies, provider offices, members, brokers, and employer groups. This position will also assist with compliance and business development activities. The Clinical Pharmacy Coordinator assists in maintaining and updating clinical policies relevant to drug utilization management. The Clinical Pharmacy Coordinator will also support the Prominence DSNP Model of Care by reviewing medications for members on that plan and communicating with prescribers to assure medications are not duplicative, interactive, and appropriately dosed for the elderly as part of an Interdisciplinary Care Team. Benefit Highlights: Loan Forgiveness Program Challenging and rewarding work environment Competitive Compensation & Generous Paid Time Off Excellent Medical, Dental, Vision and Prescription Drug Plans 401(K) with company match and discounted stock plan SoFi Student Loan Refinancing Program Career development opportunities within UHS and its 300+ Subsidiaries! · More information is available on our Benefits Guest Website: benefits.uhsguest.com About Universal Health Services: One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

Requirements

Pharm.D. or BS Pharmacy
Active/Current Pharmacist licensure in good standing
Experience applying clinical criteria in prior authorization review setting
Proven experience in a customer-facing role.
Excellent communication skills.
Must be able to write effectively
Comfort with both phone and face-to-face communications
Familiarity with the pharmaceutical, managed care, and PBM industries
Familiarity with and ability to quickly learn multiple software tools
Claims Processing Platforms (extensive knowledge required)
CRM tools
Reporting platforms (must be able to write ad hoc queries in at least one reporting tool)
Intermediate level MS Office skills

Nice To Haves

2+ years of previous health plan experience, including Medicare Advantage
Written and verbal Spanish language proficiency
Specialized subject matter expertise in one or more of the following topics required: Home infusion pharmacy operations Commercial HMO/PPO/POS Medicare Part D Mail Service/Specialty pharmacy Pharmaceutical benefit design Oncology treatment guidelines Other facets of pharmaceutical, managed care, and PBM industries

Responsibilities

The Clinical Pharmacy Coordinator executes clinical programs related to utilization management, care management, and quality improvement.
The Clinical Pharmacist Coordinator will be responsible for pharmaceutical service request reviews and render determinations of medical necessity and appropriateness of request.
The Clinical Pharmacy Coordinator holds an active, unrestricted license or certification to practice pharmacology medicine in a state or territory of the United States.
They are qualified to render appeal determinations in addition to initial determinations and non-certifications.
The Clinical Pharmacy Coordinator Reviewers have access to consult with initial clinical reviewers, other medical advisors, licensed doctors, or peer reviewers through several modes of contact.
The position will regularly interface with the pharmacy benefits manager, pharmacies, provider offices, members, brokers, and employer groups.
This position will also assist with compliance and business development activities.
The Clinical Pharmacy Coordinator assists in maintaining and updating clinical policies relevant to drug utilization management.
The Clinical Pharmacy Coordinator will also support the Prominence DSNP Model of Care by reviewing medications for members on that plan and communicating with prescribers to assure medications are not duplicative, interactive, and appropriately dosed for the elderly as part of an Interdisciplinary Care Team.