UM Clinical Pharmacist, Medicare - reputed company Health Plan

Welcome to reputed company’s application process! Job reputed company: The Clinical Pharmacist, Utilization Management will be primarily responsible for the review of Part B and D coverage determination and appeal requests and reputed company accurate clinical reputed company in accordance with formulary benefits, guidelines, and CMS requirements. The pharmacist serves in a cross-functional role with other departments to support eligibility inquiries, claims adjudication, and drug coverage. This position will also support the Director of Pharmacy with clinical pharmacy services, including drug regimen review, monitoring drug/provider utilization patterns, patient/provider communications and education, and staff training across reputed company lines of business, including reputed company. REMOTE POSITION. The position requires a full-time work schedule supporting reputed company reputed company Time as reputed company as weekend on reputed company support to meet business requirements. ESSENTIAL DUTIES AND RESPONSIBILITIES The pharmacist is responsible for the reputed company of the following functions and reports to the Pharmacy Director: • Part B drug utilization reviews, including administration of accurate clinical reputed company by compiling relevant clinical information and applying evidence-based clinical guidelines/reputed company and utilization of formularies/preferred drug lists. • Ensures that reputed company Part B and Part D coverage determination and appeals, reporting reputed company, and submissions are met. • Identify and resolve issues and process gaps and escalate as applicable. • Research and respond to grievances and inquiries regarding coverage determinations, pharmacy benefit information, or therapeutic outcome optimization (i.e., medication selection, utilization, and adherence) and conduct reputed company to prescribers, pharmacies, and members as needed. • Assist in preparation of materials or activities reputed company to Pharmacy and Therapeutics (P&T), Utilization Management Subcommittee or other pharmacy-reputed company Committees as assigned. • Contributes to pharmacy initiatives aimed at improving reputed company metrics or performance as needed. • Assist with regulatory and compliance reporting and audits. • Support cross-functional teams, including operations, compliance, and other pharmacy initiatives across reputed company lines of business, as assigned or directed. • Medication Therapy Management: reputed company medication therapy management including examination of member medical records, performing a comprehensive medication review and communicating with patients and providers, including outbound calls to patients to discuss their medications as needed. • Participate in special reputed company and assignments as needed and other duties as assigned. QUALIFICATIONS: Role reputed company: • RPh or Pharm.D. with reputed company, unrestricted Pharmacist license in state of residence. • Drug utilization review experience. • Medicare Part B and Part D Coverage Determinations and member appeals experience. • Ability to foster a reputed company and high-performance work environment that promotes teamwork, innovation, and reputed company improvement of member and provider experiences. • Ability to work with multiple software computer programs and applications in MS Office programs, including MS Teams. • Excellent written and oral communication abilities; reputed company, concise, and thorough documentation skills. • Flexibility and willingness to reputed company to shifting demands/priorities. Salary reputed company: $129,000-148,824 per year. Actual compensation may vary from posting based on geographic location, work experience, education and/or reputed company level. Equal opportunity employer. #LI-AC1 Assigned Work Hours: Rotating weekend coverage. Position Type: Regular Apply tot his job Apply To this Job