Clinical UM Pharmacist – Prior Authorization & Policy

Healthfirst; Tennessee; On-site; USD 89,000 - 132,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

401k contributions

Job summary

Healthfirst in New York is seeking a Clinical UM Pharmacist to review prior authorization requests for medications, calculate billable units, and develop clinical criteria for provider administered meds. You will stay current with literature, present drug utilization reviews, and collaborate with physicians and Medical Directors to justify review decisions; regulatory compliance with CMS/NYSDOH emphasized.

Candidates must be NY-licensed pharmacists with at least 1 year in prior authorization

Qualifications

• Pharmacy degree from an accredited school.
• Registered Pharmacist in New York with a license in good standing.
• Minimum 1 year experience conducting prior authorization reviews.
• Strong clinical knowledge of pharmaceuticals and disease states.

Responsibilities

• Monitor and review prior authorization requests for medications.
• Calculate billable units based on dosing and patient factors.
• Develop clinical criteria and medical policies for medication reviews.
• Ensure criteria compliance with CMS and NYSDOH.
• Present drug utilization reviews for medical benefit medications.

Skills

Pharmacy degree

NY Pharmacist license

Prior auth reviews

Clinical writing

Critical thinking

Education

Pharmacist degree

Tools

MS Outlook

MS Word

MS PowerPoint

Excel

Job description

Healthfirst in New York is seeking a Clinical UM Pharmacist to review prior authorization requests for medications, calculate billable units, and develop clinical criteria for provider administered meds. You will stay current with literature, present drug utilization reviews, and collaborate with physicians and Medical Directors to justify review decisions; regulatory compliance with CMS/NYSDOH emphasized.

Candidates must be NY-licensed pharmacists with at least 1 year in prior authorization