Remote Clinical Pharmacy Specialist – Prior Authorization

UPMC; Pittsburgh (Allegheny County); Hybrid; USD 110,000 - 150,000; Full time

Benefits offered by this job

Work from home

Daylight hours 8–5 EST

Job summary

UPMC Health Plan is hiring a full-time Clinical Pharmacy Specialist to support the Prior Authorization Team within the Pharmacy Services department. This is a work-from-home position with daylight hours 8:00 a.m.–5:00 p.m. EST.

Must be licensed in PA and eligible for licensure by examination or reciprocity. The role provides clinical expertise to develop, implement, and manage the pharmacy benefit, supporting utilization management and member care through prior authorization and appeals

Qualifications

• Must be licensed in PA.
• Registration as a registered pharmacist (RPh) in PA or eligibility for licensure by examination or reciprocity is required.
• Must be legally authorized to work in the United States, without sponsorship now or in the future.

Responsibilities

• Perform the clinical review of Prior Authorization, Step Therapy, Quantity Limit, and other utilization management requests per quality, timeliness and efficiency standards.
• Critically review requests for approval/denial against clinical criteria and policies.
• Participate in a clinical call queue to address inquiries from internal and external stakeholders.”
• Participate in the pharmacy appeals process through review of denied cases and as committee representation at fair hearings.
• Participate in other operational initiatives as needed.

Skills

Clinical pharmacy expertise

Prior authorization / utilization管理

Education

Pharmacist license (RPh)

Job description

UPMC Health Plan is hiring a full-time Clinical Pharmacy Specialist to support the Prior Authorization Team within the Pharmacy Services department. This is a work-from-home position with daylight hours 8:00 a.m.–5:00 p.m. EST.

Must be licensed in PA and eligible for licensure by examination or reciprocity. The role provides clinical expertise to develop, implement, and manage the pharmacy benefit, supporting utilization management and member care through prior authorization and appeals