Clinical UM Pharmacist: Prior Authorization & Policy

HealthFirst; United States; A distancia; USD 88.000 - 149.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical insurance

Dental insurance

Vision insurance

401k

Descripción de la vacante

HealthFirst is seeking a Clinical UM Pharmacist to review prior authorization requests for medications under the medical benefit, develop clinical criteria and medical policies, and stay current with literature and trends in medicine. You will work with prescribing physicians and Medical Directors to discuss rationale for review decisions.

The role requires NY pharmacist license, 1 year POA review experience, strong clinical writing and verbal skills, and the ability to collaborate across

Formación

• Pharmacy degree from an accredited school of pharmacy.
• Registered Pharmacist in the state of New York with a license in good standing.
• Minimum of 1 year experience conducting prior authorization reviews
• Strong clinical knowledge of pharmaceuticals and disease states to conduct prior authorization reviews
• Strong clinical writing and verbal skills
• Demonstrated critical thinking and problem-solving skills.
• Knowledge of specialty pharmaceuticals and billing practices in medical and pharmacy benefits
• Passion for learning, promoting the profession of pharmacy, and interest in growing skills in a dynamic environment

Responsabilidades

• Monitor and review prior authorization requests for medications
• Calculate appropriate billable units based on dosing, indication, weight, BMI and other clinical considerations
• Develop clinical criteria and medical policies for the review of medications
• Ensure all clinical criteria is in compliance with CMS and NYSDOH
• Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
• Perform and present drug utilization reviews (DUR) on medical benefit medications to assess clinical appropriateness, safety, and cost-effectiveness
• Ensure prior authorization reviews are conducted in timeframes set forth by CMS and NYSDOH
• Work across departments as needed to complete Utilization Management reviews
• Review monthly reports and present on trends, ideas for efficiency/innovation, and medical spend
• Ability to work well in a team environment and be a team player
• Additional duties as assigned or required

Conocimientos

Clinical knowledge

Verbal skills

Clinical writing

Critical thinking

Team collaboration

Educación

Pharmacy degree

Herramientas

Microsoft Outlook

Microsoft Word

PowerPoint

Excel

Descripción del empleo

HealthFirst is seeking a Clinical UM Pharmacist to review prior authorization requests for medications under the medical benefit, develop clinical criteria and medical policies, and stay current with literature and trends in medicine. You will work with prescribing physicians and Medical Directors to discuss rationale for review decisions.

The role requires NY pharmacist license, 1 year POA review experience, strong clinical writing and verbal skills, and the ability to collaborate across