Clinical Pharmacist Utilization Management - Remote PST

Overview

Join to apply for the Clinical Pharmacist Utilization Management - Remote PST role at Optum
.

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. 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. This is a full-time position with variable hours between 7:00 am to 6:00 pm MST or PST, Monday - Friday (Five 8-hour days).

Rotating weekend coverage. 100% telecommuter position.

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.

If you possess a current unrestricted Pharmacist license to practice in AZ, CA, NM, NV, UT, , WA or OR and are able to work 8a-6p PST, you will have the flexibility to work remotely as you take on some tough challenges.

Primary Responsibilities

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

Required Qualifications

• Doctor of Pharmacy degree (Pharm
  
  D)
• Current unrestricted Pharmacist license to practice in AZ, CA, NM, NV, UT, , WA or OR
• Willing to pursue licensure in additional states to include AZ, CA, NM, NV, UT, , WA & OR
• 3+ years of experience as a Prior Authorization Pharmacist or Clinical Pharmacist, conducting such activities as medication therapy management, clinical rounds, disease state management, etc. Relevant experience includes ANY of the following or a combination thereof:
• Retail pharmacy
• Pharmacy Benefit Management
• Infusion or hospital pharmacy experience
• 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

Preferred Qualifications

• Board certification by the Board of Pharmacy Specialties (BPS)
• 1+ years of experience in Oncology Setting
• Certified Geriatric Pharmacist
• AZ Unrestricted Pharmacist License
• CO Unrestricted Pharmacist License
• NM Unrestricted Pharmacist License
• NV Unrestricted Pharmacist License
• UT Unrestricted Pharmacist License
• WA Unrestricted Pharmacist License
• OR Unrestricted Pharmacist License
• Pharmacist License
• Proven knowledge of Medicare,…