Temporary Clinical Pharmacy Specialist- Prior Authorization Team

University of Pittsburgh Medical Center • Pittsburgh, PA

293d • Remote

About The Position

UPMC Health Plan is hiring a temporary Clinical Pharmacy Specialist to support the Prior Authorization Team within the Pharmacy Services department. This is a work-from-home position, working flexible hours. Located anywhere in the United States but must be licensed in PA. The Clinical Pharmacy Specialist provides clinical pharmacy expertise to the development, implementation, and management of the pharmacy benefit. The clinical pharmacist assists in the management of pharmacy utilization and provides expertise in managing member care through the prior authorization and appeals process for medications. These services will be provided in compliance with state and federal regulations including NCQA and CMS standards while upholding the mission, policies and procedures of UPMC Health Plan and Pharmacy Department. Individual candidates should demonstrate professionalism and commitment to meet UPMC HP goals and objectives.

Requirements

• Bachelor of Science Degree in Pharmacy or Doctor of Pharmacy Degree (Pharm.D.) from an accredited U.S. School of Pharmacy.
• Minimally, 1-3 years practicing as a licensed pharmacist.
• Experience in pharmacy benefit management, insurance, managed care required.
• Effective communication skills, both written and oral.
• Demonstrate proficient analytical ability and organizational skills.
• Must possess strong drug information and literature evaluation skills.
• Computer literacy for word processing, data management and navigating different computer applications daily.
• Assessment of job-related skills and competency will be reviewed annually via daily functioning, job-related documentation, department-based competency programs, and continuing education activities.

Responsibilities

• Performing the clinical review of Prior Authorization, Step Therapy, Quantity Limit, and all other pharmacy utilization requests in accordance with quality, timeliness, and efficiency standards.
• Critically reviewing medication based prior authorization requests and utilization management requests for approval/denial against standard clinical criteria.
• Participate and contribute to other clinical and efficiency initiatives on an as needed basis.
• Maintain a foundational understanding of the requirements of the Pennsylvania Department of Human Services, DHS, Centers for Medicare & Medicaid Services, CMS, and the National Committee for Quality Assurance, NCQA, specifically as they relate to the expectations of pharmacy operations.
• Ensure compliance with regulatory requirements of clinical operational functions.
• Foster and maintain collaborative relationships with internal and external customers.
• Communicate pharmacy information as appropriate to stakeholders.
• Function independently but support a virtual team concept.
• Demonstrate reliability as shown by prompt attendance and timely completion of designated workload and follow-up.
• Convey and maintain a professional image while interacting with coworkers, providers, and clients.
• Honor client and patient confidentiality.
• Leverage thorough drug information skills to adequately research drugs and disease states pertaining to complex utilization management reviews or other ancillary responsibilities.

What This Job Offers

• Industry: Hospitals
• Education Level: Bachelor's degree