Pharmacist - Utilization Management (um) - (remote)

Highmark Health

Working At Home, PA, United States
Base: $102,700.00 - $164,600.00; bonus/equity: not...
Prior authorization review
Medication coverage determination
Evaluate clinical information
This job reviews requests for medication coverage determination for prior authorization review and appeals

Job Summary

  • This job reviews requests for medication coverage determination for prior authorization review and appeals.
  • Through the Utilization Review system, the incumbent evaluates clinical information provided by the physician against medical policy criteria.
  • The incumbent then uses his/her clinical knowledge compared to the policy and physician request to make a determination.

Matching Summary

This job reviews requests for medication coverage determination for prior authorization review and appeals.

Salary

Base: $102,700.00 - $164,600.00; Bonus/Equity: Not specified; Benefits: Not specified

Skills & Requirements

Must-have

  • Prior authorization review
  • Medication coverage determination
  • Evaluate clinical information
  • Medical policy criteria
  • Utilization Review system

Nice-to-have

  • Additional research beyond policy
  • Update system records
  • Oral & Written Communication Skills
  • Problem Solving & Decision Making

Key Requirements

  • Registered Pharmacist
  • 1 - 3 years in Pharmacy
  • Bachelor's degree in Pharmacy

Work Rights

Not specified

Tailored Resume

Cover Letter