Pharmacist, Utilization Management & Appeals (Clinical)

wvumedicine; United States; À distance; USD 110 000 - 150 000; Plein temps

Résumé du poste

PHH Peak Health Holdings is seeking a Clinical Utilization Management Pharmacist to perform drug utilization review for initial determinations and appeals for ASO clients, Medicare Advantage, and future lines of business.

You will collaborate with the Medical Director and formulary team on specialty reviews, identify utilization trends, and ensure timely, regulatory-compliant reviews across multiple lines of business.

Qualifications

• Current and unrestricted pharmacist license in state of residence.
• 3 years of clinical pharmacist experience.
• 2 years of managed care experience.

Responsabilités

• Make prior authorization and step-therapy determinations for DRR across all lines of business.
• Participate in the appeals process for drug reviews.
• Own the operational execution of the drug utilization review process.
• Serve as SME for utilization management related to drug reviews.

Connaissances

Clinical pharmacy

Regulatory knowledge

Communication

MS Office

Problem solving

Formation

Pharmacist license

Outils

Microsoft Office

Description du poste

PHH Peak Health Holdings is seeking a Clinical Utilization Management Pharmacist to perform drug utilization review for initial determinations and appeals for ASO clients, Medicare Advantage, and future lines of business.

You will collaborate with the Medical Director and formulary team on specialty reviews, identify utilization trends, and ensure timely, regulatory-compliant reviews across multiple lines of business.