Clinical Pharmacist, Utilization Management - Part B Drugs

Clinical Pharmacist, Utilization Management (Part B Drugs)

locations

Remote USA

time type

Full time

job requisition id

R2720

Job Description

A bit about this role:

This position represents an amazing opportunity for an ambitious early-mid career pharmacist to join a high performing pharmacy team. You’ll be a core member of the Pharmacy Team’s Utilization Management department to work on controlling the costs of complex treatments. You will strive to ensure that our members get the right treatment at the right time all while supporting the mission of our company to treat each member like family along the way.  We are committed to helping and supporting you to learn and gain the experience that you need to achieve your career development goals. This is an exciting opportunity to help us build and grow our health plan pharmacy program and deliver the best possible care to our members!

Your Responsibilities and Impact will include:

Utilization Management

• Reviewing prior authorization requests for drugs and biologics, as well as products covered under our part B benefit.

• Reviewing appeals of previously denied requests.

• Ensuring members (and their providers) understand their benefits and how they can be used to better their health.

• Providing support for internal clinical and non-clinical staff in understanding our policies and procedures.

Required skills and experience:

• A pharmacist (RPh) with 2 or more years of utilization management experience and/or completion of a managed care residency. Applicable specialty pharmacy experience also considered.

• Doctorate of Pharmacy degree (PharmD).

• Actively licensed in at least one state. 

• Must be willing to work Monday-Friday 12PM to 8:30PM EST (Eastern Standard Time). Rotating weekend on call and holidays is required.

• Experience with pharmacy-related quality assurance (QA) work is strongly preferred but not required (examples include experience performing medication reconciliation during transitions of care or helping to design and/or implement other pharmacy-related quality improvement programs).

Desired skills and experience:

• An appreciation of Medicare regulations and policies and how Medicare pays for drugs. 

• A keen understanding of how the interactions between payers, providers, and drug manufacturers ultimately affect the patient.

• Experience working as part of a multidisciplinary care team, especially during transitions of care.

Salary Range: $75,000 - $140,000/year

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium

• Generous paid time off

• $100 monthly mobile or internet stipend

• Stock options for all employees

• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles

• Parental leave program

• 401K program

• And more....