Clinical Pharmacist - Utilization Management & Prior Auth

Highmark Health; Penn (Westmoreland County); On-site; USD 103,000 - 165,000; Full time

Benefits offered by this job

Health benefits

Job summary

Highmark Inc. is seeking a Pharmacist to review medication coverage requests for prior authorization and appeals. You will evaluate clinical information against policy criteria and determine coverage decisions, sometimes researching beyond the policy to support results.

In this role you will ensure accurate system updates, handle documentation, and perform related duties. Must hold a Pharmacy degree and license, with 1–3 years of pharmacy experience; Doctorate preferred.

Qualifications

• Bachelor's degree in Pharmacy is required.
• Doctorate in Pharmacy is preferred.
• Registered Pharmacist license is required.
• 1–3 years of pharmacy experience required.

Responsibilities

• Make coverage determinations by evaluating prior authorization requests and appeals against medical policy.
• Research beyond medical policy to support coverage decisions.
• Other duties as assigned.

Skills

Oral & Written Communication Skills

General Computer Skills

Problem Solving

Compliance

Prioritizing

Education

Bachelor's degree in Pharmacy

Doctorate degree in Pharmacy

Job description

Highmark Inc. is seeking a Pharmacist to review medication coverage requests for prior authorization and appeals. You will evaluate clinical information against policy criteria and determine coverage decisions, sometimes researching beyond the policy to support results.

In this role you will ensure accurate system updates, handle documentation, and perform related duties. Must hold a Pharmacy degree and license, with 1–3 years of pharmacy experience; Doctorate preferred.