Schedule Notes:
Training will be 9:00am – 5:30pm EST….their shift will be 9:30am – 6:00pm in their time zone starting 100% remote.
Duties:
Utilization management pharmacists are responsible for reviewing each plans policy to determine if coverage can be granted for a medication.
Provide clinical support and oversight for all utilization management (UM) activities.
Responsible for finalizing all denials of clinical prior authorization requests.
Skills:
- 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.
3 Non-Negotiable Skills:
- Utilization Management Experience Preferred
- Strong clinical knowledge
- Able to make decision