Peak Health
51 - 200 employees
⚕️ Healthcare Insurance
🤝 Non-profit
Healthcare Insurance • Non-profit
Peak Health is a health insurer and health insurance services company headquartered in Morgantown, West Virginia. It is owned by three not-for-profit health care providers: WVU Health System, Marshall Health Network, and Valley Health. Peak Health aims to improve community health outcomes by offering an inclusive, provider-led health plan for residents of West Virginia and surrounding areas. The company is committed to making health care more accessible, understandable, and collaborative, with a focus on reducing costs and administrative fees for patients and employers. Peak Health also offers Medicare Advantage coverage tailored for West Virginia seniors through partnerships with leading health systems.
Clinical Utilization Management Pharmacist
🕒 May 15
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Peak Health
51 - 200 employees
⚕️ Healthcare Insurance
🤝 Non-profit
Healthcare Insurance • Non-profit
Peak Health is a health insurer and health insurance services company headquartered in Morgantown, West Virginia. It is owned by three not-for-profit health care providers: WVU Health System, Marshall Health Network, and Valley Health. Peak Health aims to improve community health outcomes by offering an inclusive, provider-led health plan for residents of West Virginia and surrounding areas. The company is committed to making health care more accessible, understandable, and collaborative, with a focus on reducing costs and administrative fees for patients and employers. Peak Health also offers Medicare Advantage coverage tailored for West Virginia seniors through partnerships with leading health systems.
📋 Description
• Performing drug utilization review for initial determinations and/or appeals for ASO clients, Medicare Advantage plan. • Collaborating as an integral member of the pharmacy team. • Ensure the timely execution of all drug reviews in compliance with accreditation and regulatory standards. • Work with Medical Director and Clinical Formulary team to review any specialty medication requiring a specialty consult as defined by our formulary team. • Identify any utilization review trends and areas of improvement that need to be addressed.
🎯 Requirements
• Must possess current and unrestricted license to practice 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. • Specific knowledge of CMS regulations, HIPAA and regulatory environment.
🏖️ Benefits
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. • Some travel may be required to offsite meetings.
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