Remote Clinical UM Pharmacist
Remote Clinical UM Pharmacist
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Job Description
Job Title: Remote Clinical UM Pharmacist
Job Location: Florida USA
Job Location Type: Remote
Job Contract Type: Fulltime
Job Seniority Level:
Duties & Responsibilities
- Monitor and review prior authorization requests for medications
- Calculate appropriate billable units based on dosing indication weight BMI and other clinical considerations
- Develop clinical criteria and medical policies for the review of medications
- Ensure all clinical criteria is in compliance with Center of Medicare and Medicaid Services (CMS) and the New York State Department of Health (NYSDOH)
- Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
- Ensure prior authorization reviews are conducted in timeframes set forth by CMS and/or NYSDOH
- Work across departments as needed to complete Utilization Management reviews
- Review monthly reports and provide feedback on trends ideas for efficiency and innovation
- Ability to work well in a team environment and be a team player
- Additional duties as assigned or required
- Pharmacy degree from an accredited school of pharmacy
- Registered Pharmacist with a state license in good standing.
- Work experience conducting prior authorization reviews
- Clinical knowledge of pharmaceuticals and disease states in order to conduct prior authorization reviews
- Work experience requiring written and verbal clinical communication that is clear concise grammatically correct and professional
- Knowledge of specialty pharmaceuticals and billing practices in the medical and pharmacy benefits
- PGY1 Managed Care Residency
- Knowledge of regulations of the Centers for Medicare and Medicaid Services including but not limited to National and Local Coverage Determinations
- Demonstrated critical thinking and problemsolving skills
- Passion for learning promoting the profession of pharmacy and interest in growing skills in a dynamic environment with various opportunities
- Experience leading large and small working meetings
- PC Skills with Microsoft Outlook Word PowerPoint (creating presentations and slides) and Excel (Pivot tables)
Regulatory Or Compliance Activities
Assists in regulatory and compliance audits for all plans. Ensure all activities are conducted in compliance with regulations.
Hiring Range*:
- Greater New York City Area (NY NJ CT residents): $100900 $145775
- All Other Locations (within approved locations): $86500 $128690
In addition to your salary Healthfirst offers employees a full range of benefits such as medical dental and vision coverage incentive and recognition programs life insurance and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
- The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire or for a job promotion or transfer into this role.
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Employment Type
Full Time
