Pharmacist - Utilization Management; UM Remote

JOB SUMMARY

This role reviews medication coverage determinations for prior authorization requests and appeals. The incumbent evaluates clinical information against medical policy criteria using the Utilization Review system, then makes coverage determinations and routes claims appropriately.

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

• 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

None

None

$67,500.00

$

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