Pharmacist, Clinical Utilization Management - Archimedes

Archimedes; Madison (WI); Remote; USD 110,000 - 160,000; Full time

Benefits offered by this job

Health, Dental, and Vision insurance

20 days paid time off

4 weeks paid parental leave

9 paid holidays

401K company match 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan

Professional Membership assistance

Referral Bonus Program – up to $750

Job summary

Archimedes in Wisconsin seeks a Pharmacist, Clinical Utilization Management to lead utilization management for specialty medications across pharmacy and medical benefits. You will engage with physicians, nurses, and pharmacists to optimize prior authorizations, high-cost case reviews, and therapeutic substitutions, while analyzing data to shape clinical policies.

Responsibilities include peer-to-peer consultations, clinical outreach, and presenting cost-effectiveness information to plan

Qualifications

• Bachelor’s degree in Pharmacy or PharmD is required.
• Current, unrestricted Pharmacist license in the state of residence or reciprocity within 4 months.
• Experience in pharmacy settings and benefits programs preferred.
• Proficiency with Microsoft Office applications required.

Responsibilities

• Develop and deliver clinical messages to physicians, members, clients, and consultants.
• Manage prior authorization, high-cost cases, claims editing and clinical policy development.
• Conduct prior authorization outreach to prescribers to obtain clinical information and support timely case resolution.
• Communicate with prescribers and other clinical stakeholders by phone, email, or fax.
• Engage in evidence-based clinical conversations to explain utilization criteria and alternatives.
• Serve as a clinical resource for member-facing teammates and support for inquiries.
• Present deep clinical and cost-effectiveness information as a subject matter expert.
• Other duties as assigned.

Skills

Clinical communication

Managed care experience

Prior authorization

Team collaboration

Education

Bachelor’s degree in Pharmacy or PharmD

Tools

Microsoft Excel

PowerPoint

Word

Job description

Overview

Archimedes is seeking a Pharmacist, Clinical Utilization Management to join our team!

The Pharmacist, Clinical Utilization Management is the clinical expert for all specialty medications across both the pharmacy and the medical benefit. This role will communicate with physicians, nurses, pharmacists, and members related to high-cost case concerns, dose management, genetic testing, therapeutic substitutions, and cost management related to specialty drugs.

The Pharmacist, Clinical Utilization Management will serve as a clinical subject matter expert and conduct peer to peer consultations with physicians. This position is divided into two areas: external clinical outreach activities related to high-cost case management and prior authorization of specialty medications, across pharmacy and medical benefits and specialty and traditional drugs. In addition, this role will have the opportunity to evaluate the data to identify actionable opportunities for specialty management and create clinical policies.

Responsibilities

How do I make an impact on my team?

• Develop and deliver clinical messages to physicians, members, clients, and consultants.
• Manage prior authorization, high-cost cases, claims editing and clinical policy development.
• Conduct prior authorization outreach to prescribers to obtain clinical information, clarify requests, and support timely case resolution.
• Communicate with prescribers and other clinical stakeholders by phone, email, or fax regarding prior authorization requests, clinical documentation, and benefit requirements.
• Engage in evidence-based clinical conversations with prescribers to explain utilization management criteria, coverage determinations, and appropriate therapeutic alternatives.
• Serve as a clinical resource for member-facing teammates, providing prior authorization guidance, clinical context, and support for member inquiries.
• Communicate directly with members on an as-needed basis to address prior authorization questions and support understanding of clinical or coverage-related information.
• Clinical program development including both medical and pharmacy benefit management.
• Define, document, and deliver results for plan sponsors.
• Evaluate and summarize clinical literature as well as financial implications related to medication management options.
• Present deep clinical and cost effectiveness information as subject matter expert.
• Other duties as assigned.

Qualifications

What our team expects from you?

• Bachelor’s degree in Pharmacy or PharmD degree required.
• Current, unrestricted licensure as a Registered Pharmacist in the state of residence, or the ability to gain reciprocity within 4 months, may be required based on state of residence laws or client contracts. Other State Pharmacy Licenses may be required as business need dictates. Board of Pharmacy Certification preferred for Pharmacotherapy, Ambulatory Care or Oncology Care.
• Pharmacy experience in retail, hospital, managed care, or other pharmacy-related setting preferred.
• Experience and knowledge in Pharmacy and Medical specialty benefits preferred.
• Proficiency in Microsoft Excel, PowerPoint, and Word required.
• Experience with physician-facing clinical communication preferred.
• Participate in, adhere to, and support compliance program objectives.
• The ability to consistently interact cooperatively and respectfully with other employees.

What can you expect from Archimedes?

• Top of the industry benefits for Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5% - No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program – up to $750!

#LI-Remote

Navitus Health Solutions is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, veteran status or any other characteristic protected by law.

Equal employment opportunity, including veterans and individuals with disabilities.

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