Pharmacist - Utilization Management (UM) Remote

Highmark Health

2d • Remote

About The Position

This job reviews requests for medication coverage determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by the physician against medical policy criteria. The incumbent then uses his/her clinical knowledge compared to the policy and physician request to make a determination. At times, the incumbent may conduct additional research beyond medical policy review to make coverage determinations.

Requirements

• Bachelor's degree in Pharmacy
• 1 - 3 years in Pharmacy
• Registered Pharmacist
• Oral & Written Communication Skills
• General Computer Skills
• Problem Solving & Decision Making
• Compliance
• Prioritizing

Nice To Haves

• Doctorate degree in Pharmacy

Responsibilities

• Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the Utilization Review system.
• Update the system records appropriately to ensure claims are properly routed and paid.
• Conduct research beyond medical policy review to make decisions on medication coverage requests.
• Other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees