Pharmacist, Utilization Management & Clinical Review

WVU Medicine; United States; À distance; USD 110 000 - 140 000; Plein temps

Résumé du poste

PHH Peak Health Holdings in the United States seeks a Clinical Utilization Management Pharmacist to perform drug utilization reviews and participate in appeals across multiple lines of business. The role collaborates with the Medical Director and formulary team on specialty reviews and utilizes data to improve formulary and utilization strategies.

The position requires an active state license, 3 years of clinical experience, and 2 years in managed care, with strong MS Office skills and excellent

Qualifications

• Current and unrestricted pharmacy license in state of residence.
• Three years of clinical pharmacist experience.
• Two years of managed care experience.
• Knowledge of CMS regulations, HIPAA and regulatory environment.
• Strong communication and presentation skills.

Responsabilités

• Make prior authorization and step therapy determinations based on clinical evidence and documentation.
• Participate in appeals process for drug reviews across lines of business.
• Own the operational execution of the drug utilization review process.
• Serve as inter-departmental subject matter expert for utilization management.
• Identify review trends and policy needs with leadership.

Connaissances

Clinical pharmacy

Utilization management

Communication skills

Presentation skills

Team collaboration

MS Office (Excel, Access)

Formation

Active pharmacist license

Outils

Microsoft Office

Description du poste

PHH Peak Health Holdings in the United States seeks a Clinical Utilization Management Pharmacist to perform drug utilization reviews and participate in appeals across multiple lines of business. The role collaborates with the Medical Director and formulary team on specialty reviews and utilizes data to improve formulary and utilization strategies.

The position requires an active state license, 3 years of clinical experience, and 2 years in managed care, with strong MS Office skills and excellent