Clinical UM Pharmacist - Prior Authorization & Policy Lead

Healthfirst; Florida; On-site; USD 89,000 - 149,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Incentive and recognition programs

Life insurance

401k contributions

Job summary

Healthfirst seeks a Clinical UM Pharmacist to review prior authorization requests, develop clinical criteria for provider administered medications, and monitor quality through monthly reports. The role requires NY Pharmacist license and a pharmacy degree, with at least 1 year of prior authorization experience.

You will collaborate with prescribing physicians and Medical Directors to support decisions, stay current with literature, and ensure CMS/NYSDOH compliance in a dynamic care environment.

Qualifications

• Pharmacy degree from an accredited school of pharmacy.
• Registered Pharmacist in NY with license in good standing.
• Minimum of 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, indication, weight, BMI.
• Develop clinical criteria and medical policies for review of medications.
• Research drug information to support prior authorization reviews.
• Present drug utilization reviews (DUR) on medical benefit medications.

Skills

Prior authorization review

Clinical knowledge

Written & verbal communication

Critical thinking

Team collaboration

Education

Pharmacy degree from an accredited school

Licensed pharmacist in NY

Tools

Microsoft Outlook

Microsoft Word

Microsoft PowerPoint

Microsoft Excel

Job description

Healthfirst seeks a Clinical UM Pharmacist to review prior authorization requests, develop clinical criteria for provider administered medications, and monitor quality through monthly reports. The role requires NY Pharmacist license and a pharmacy degree, with at least 1 year of prior authorization experience.

You will collaborate with prescribing physicians and Medical Directors to support decisions, stay current with literature, and ensure CMS/NYSDOH compliance in a dynamic care environment.