Clinical Pharmacist, Utilization Management - Remote Options

Excellus Health Plan Inc. in; City of Rochester (NY); On-site; USD 110,000 - 198,000; Full time

Job summary

Excellus Health Plan Inc. is seeking a Clinical Pharmacist for Utilization Management (Finance) to support Medicare, Commercial, Marketplace and Medicaid. The pharmacist focuses on quality, safety and cost of medications through medical management across benefits.

Responsibilities include drug prior authorizations, appeals, and collaboration with providers and internal staff. Requires NYS Pharmacist license and Pharm.D. (or Bachelors in Pharmacy).

Qualifications

• Unrestricted NYS Pharmacist license.
• Pharm.D. required; in lieu, a Bachelors in Pharmacy accepted.

Responsibilities

• Conduct drug prior authorization, exception and medical necessity reviews.
• Collaborate with providers and internal staff to determine coverage criteria.
• Support clinicians with drug information and case discussions.
• Lead audits and participate in policy updates.
• Mentor pharmacy staff and students.

Skills

Customer service orientation

Effective communication

Microsoft Word & Excel

Data interpretation

Education

Pharm.D.

Bachelors in Pharmacy

Tools

Care management tools

Job description

Excellus Health Plan Inc. is seeking a Clinical Pharmacist for Utilization Management (Finance) to support Medicare, Commercial, Marketplace and Medicaid. The pharmacist focuses on quality, safety and cost of medications through medical management across benefits.

Responsibilities include drug prior authorizations, appeals, and collaboration with providers and internal staff. Requires NYS Pharmacist license and Pharm.D. (or Bachelors in Pharmacy).