Staff Pharmacist

The Cigna Group; United States; On-site; USD 110,000 - 140,000; Full time

Job summary

The Cigna Group is seeking a Utilization Management Pharmacist to review plan policies and determine coverage for medications. You will provide clinical support and oversight for UM activities and finalize denials for clinical prior authorization requests.

Key responsibilities include serving as a clinical resource for drug therapy questions, applying critical thinking in reviews, and collaborating with a multidisciplinary team to deliver a customer-centric experience.

Qualifications

• UM pharmacist must review plan policies to determine coverage decisions.
• Provide clinical support and oversight for utilization management activities.
• Strong clinical decision-making and ability to work with limited information.

Responsibilities

• Reviews and finalizes denials of clinical prior authorization requests.
• Supports the Coverage Review Department as a clinical resource for drug therapy questions.
• Applies critical thinking to ensure proper clinical decisions in reviews.
• Collaborates with a multi-disciplinary clinical team to deliver customer-centric service.

Skills

MS Office

Clinical knowledge

Review & decision-making

Pharmacy experience (lead/supervisor)

Specialty pharmacy experience

Education

Bachelor’s Degree in Pharmacy

PharmD preferred

Job description

Working Hours: M-F 9:30am - 6pm in their respective time zone

ROLE OVERVIEW

Utilization management pharmacists are responsible for reviewing each plan’s policy to determine if coverage can be granted for medication.

Provide clinical support and oversight for all utilization management (UM) activities.

Responsible for finalizing all denials of clinical prior authorization requests.

RESPONSIBILITIES:

Supports the Coverage Review Department (CRD) as a clinical resource for drug therapy questions

Applies critical thinking to achieve proper clinical decisions when performing clinical reviews

Utilizes multiple systems and other clinical resources to achieve proper decisions in Utilization Management reviews

Works and maneuvers within a queue system that prioritizes clinical reviews

Makes clinical decisions quickly and at times decides and acts with limited information

Works and collaborates with a multi-disciplinary clinical team to provide a customer centric experience

SKILLS:

Proficient technical skills utilizing Microsoft Office applications required

Strong Clinical Knowledge

Detailed Review and Decision-Making ability

2+ years lead/supervisor or retail pharmacy experience preferred

Experience with Specialty Pharmacy/Pharmaceuticals preferred

EDUCATION & CERTIFICATIONS:

Bachelor’s Degree in Pharmacy required; PharmD preferred