Pharmacist UM: Prior Authorization & Policy Review

Highmark Health; Pennsylvania; Teletrabalho; USD 103 000 - 165 000; Tempo integral

Resumo da oferta

Highmark Inc. is seeking a Pharmacist to review medication coverage requests for prior authorization and appeals.

Using the Utilization Review system, you will evaluate clinical information against policy criteria and determine coverage decisions, with occasional additional research when needed. Required are a Bachelor's degree in Pharmacy and a Registered Pharmacist license, with 1–3 years of pharmacy experience.

Qualificações

• Bachelor's degree in Pharmacy required.
• Registered Pharmacist license required.
• Doctorate in Pharmacy preferred.

Responsabilidades

• Make coverage determinations by evaluating requests for prior authorization or appeals against medical policy.
• Research beyond medical policy to support coverage decisions.
• Other duties as assigned.

Conhecimentos

Oral & Written Communication Skills

General Computer Skills

Problem Solving & Decision Making

Compliance

Prioritizing

Formação académica

Bachelor's degree in Pharmacy

Doctorate degree in Pharmacy

Descrição da oferta de emprego

Highmark Inc. is seeking a Pharmacist to review medication coverage requests for prior authorization and appeals.

Using the Utilization Review system, you will evaluate clinical information against policy criteria and determine coverage decisions, with occasional additional research when needed. Required are a Bachelor's degree in Pharmacy and a Registered Pharmacist license, with 1–3 years of pharmacy experience.