Clinical UM Pharmacist - Prior Authorization & Policies

Healthfirst; Texas; Presencial; USD 89.000 - 149.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental and vision coverage

Life insurance

401k contributions

Descripción de la vacante

Healthfirst in New York is seeking a Clinical UM Pharmacist to review prior authorization requests for medications under the medical benefit and to develop clinical criteria and medical policies for provider-administered medications.

The role requires collaboration with prescribing physicians and Medical Directors, strong clinical writing, and up-to-date knowledge of CMS/NYSDOH guidelines to ensure timely reviews and evidence-based decisions.

Formación

• Pharmacist licensed in NY in good standing.
• Minimum of 1 year experience conducting prior authorization reviews.
• Strong clinical knowledge of pharmaceuticals and disease states.
• Strong clinical writing and verbal skills.
• Demonstrated critical thinking and problem-solving skills.
• Knowledge of specialty pharmaceuticals and medical billing practices.
• Passion for learning and growing skills in a dynamic environment.

Responsabilidades

• Monitor and review prior authorization requests for medications.
• Calculate billable units based on dosing, indication, weight, BMI and other clinical factors.
• Develop clinical criteria and medical policies for medication reviews.
• Ensure criteria complies with CMS and NYSDOH requirements.
• Research drug information to support prior authorization decisions.
• Perform drug utilization reviews for medical benefit medications.

Conocimientos

Pharmacist license NY

Prior authorization review

Clinical writing

Critical thinking

Team collaboration

Billing knowledge

Disease state knowledge

Learning mindset

Educación

Pharmacy degree

Herramientas

Microsoft Office

Descripción del empleo

Healthfirst in New York is seeking a Clinical UM Pharmacist to review prior authorization requests for medications under the medical benefit and to develop clinical criteria and medical policies for provider-administered medications.

The role requires collaboration with prescribing physicians and Medical Directors, strong clinical writing, and up-to-date knowledge of CMS/NYSDOH guidelines to ensure timely reviews and evidence-based decisions.