Staff Pharmacist

The Cigna Group; United States; On-site; USD 90,000 - 120,000; Full time

Job summary

The Cigna Group is seeking a pharmacist to lead utilization management activities, reviewing plan policies to determine coverage for medications and finalizing denials for prior authorization requests.

You will provide clinical support to the Coverage Review Department, apply critical thinking during reviews, and collaborate with a multidisciplinary team to deliver customer-centric outcomes.

Qualifications

• Proficient in Microsoft Office applications.
• Strong clinical knowledge and analytical skills.
• Detail-oriented with solid decision-making abilities.
• 2+ years of lead/supervisor or retail pharmacy experience preferred.
• Experience with Specialty Pharmacy/Pharmaceuticals preferred.

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 within a queue system that prioritizes clinical reviews
• Makes clinical decisions quickly and sometimes with limited information
• Collaborates with a multi-disciplinary clinical team to provide a customer centric experience

Skills

Clinical knowledge

Decision making

Review with limited information

Leadership / supervisory experience

Specialty pharmacy experience

Education

Bachelor's Degree in Pharmacy

PharmD preferred

Tools

Microsoft Office

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