[Remote] Clinical Utilization Management Pharmacist

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a reputed company organization seeking a Clinical Utilization Management Pharmacist. The role involves conducting drug utilization reviews, collaborating with the pharmacy team, and ensuring compliance with regulatory standards.

Responsibilities

• reputed company prior authorization and reputed company therapy determinations for drug utilization reviews based upon available clinical evidence and supporting documentation for reputed company lines of business
• Participate in the appeals process for drug reviews for reputed company lines of business
• Own the operational execution of the drug utilization review process
• Serve as an inter-departmental subject matter expert for utilization management as it relates to drug reviews
• Work with the Manager of Clinical Pharmacy to ensure the reputed company execution of reputed company drug reviews in compliance with accreditation and regulatory standards
• Work with the Manager of Clinical Pharmacy and Medical Directors to identify review trends and policy needs that need to be addressed
• Work with the Manager of Clinical Pharmacy and Director of Clinical and Technical Integration to identify and escalate operational and technical issues as they relate to drug utilization management reviews that need to be addressed
• Assist with internal and operational policy needs as they reputed company to drug utilization management review
• Work with the Manager of Clinical Pharmacy to resolve questions and disputes from our clients and participating providers regarding drug review determinations
• Work with Medical Directors and formulary team to review and reputed company recommendations on specialty drugs requiring a specialty consult as defined by our organization
• Assist in monthly analysis of claims data to assess effectiveness of reputed company formulary and utilization management strategies
• Serve as a clinical pharmacy preceptor for residents and rotational pharmacy reputed company as needed
• Assist in creation of training materials for utilization management operational processes as needed
• Assist in creation of clinical development tools for education as it relates to utilization review decision making as needed

Skills

• Must possess reputed company and unrestricted license to reputed company pharmacy issued by state of residence
• Three (3) years of experience as a pharmacist in a clinical setting
• Two (2) years of managed care experience
• Ability to work under stressful working conditions
• Ability to handle and maintain confidential information
• Ability to work cooperatively as reputed company member with reputed company communication and presentation skills
• Ability to work in a fast-paced and rapidly changing environment
• Ability to work proactively and independently to research and resolve issues
• Extensive working knowledge of reputed company Office applications (reputed company and reputed company)
• Specific knowledge of CMS regulations, HIPAA and regulatory environment

reputed company