Clinical Pharmacist - Utilization Management

Harvard Pilgrim Health Care Inc

Base: $110,594.35 - $165,891.53; bonus/equity: var...
Reviewing prior authorization requests
Conducting coverage determinations
Consulting with medical directors
The Clinical Pharmacist is responsible for reviewing and managing daily caseloads of pharmacy prior authorization requests to ensure timely coverage determinations

Job Summary

  • The Clinical Pharmacist is responsible for reviewing and managing daily caseloads of pharmacy prior authorization requests to ensure timely coverage determinations.
  • Candidates will consult with Tufts Health Plan Medical Directors on cases that fail to meet drug prior authorization criteria.
  • Point32Health offers a comprehensive total rewards package including medical, dental, vision, retirement plans, and paid time off.

Matching Summary

The Clinical Pharmacist is responsible for reviewing and managing daily caseloads of pharmacy prior authorization requests to ensure timely coverage determinations.

Salary

Base: $110,594.35 - $165,891.53; Bonus/Equity: Variable pay eligible; Benefits: Medical, dental, vision, retirement, PTO, life insurance

Skills & Requirements

Must-have

  • Reviewing prior authorization requests
  • Conducting coverage determinations
  • Consulting with Medical Directors
  • Adhering to regulatory timeframes
  • Communicating with providers and members

Nice-to-have

  • Experience with automated PA tools
  • Strong interpersonal communication skills
  • Commitment to inclusion and empathy
  • Ability to work in a team environment

Key Requirements

  • Clinical Pharmacist license required
  • Pharmacy degree or equivalent qualification
  • Experience in utilization management preferred

Work Rights

Not specified

Tailored Resume

Cover Letter