Clinical UM Pharmacist

🔥 41 minutes ago

🏈 Alabama, Arizona, +35 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🌺 Hawaii – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🌪️ Oklahoma – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $88.7k - $131.9k / year

⏰ Full Time

🟢 Junior

💊 Pharmacist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 1%

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Healthfirst

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1993

🛡️ Insurance

🏥 Healthcare

⚕️ Healthcare Insurance

Insurance • Healthcare • Healthcare Insurance

Healthfirst is a health insurance provider dedicated to helping New Yorkers access affordable health coverage for individuals and families. With over 30 years of experience, Healthfirst offers a range of plans including Medicaid managed care, Medicare Advantage, long-term care, and essential health plans. The company focuses on providing quality healthcare options, comprehensive benefits, and support to ensure members can maintain their health and well-being.

📋 Description

• Monitor and review prior authorization requests for medications • Calculate appropriate billable units based on dosing, indication, weight, BMI, and other clinical considerations • Develop clinical criteria and medical policies for medication reviews • Ensure clinical criteria comply with CMS and NYSDOH requirements • Research drug information and maintain drug and disease-state knowledge • Perform and present drug utilization reviews for medical benefit medications • Complete prior authorization reviews within CMS and/or NYSDOH timeframes • Work across departments to complete Utilization Management reviews • Review monthly reports and present trends, efficiency and innovation ideas, and medical spend • Assist in regulatory and compliance audits for all plans • Ensure activities comply with applicable regulations • Perform additional duties as assigned or required

🎯 Requirements

• Pharmacy degree from an accredited school of pharmacy • Registered Pharmacist in the state of New York with a license in good standing • Minimum of 1 year experience conducting prior authorization reviews • Strong clinical knowledge of pharmaceuticals and disease states • Strong clinical writing and verbal skills • Demonstrated critical thinking and problem-solving skills • Knowledge of specialty pharmaceuticals and billing practices in the medical and pharmacy benefits • Interest in growing skills in a dynamic environment • Knowledge of Centers for Medicare and Medicaid Services regulations, including National and Local Coverage Determinations • Ability to lead large and small working meetings • PC skills with Microsoft Outlook, Word, PowerPoint, and Excel, including Pivot tables

🏖️ Benefits

• Medical, dental and vision coverage • Incentive and recognition programs • Life insurance • 401k contributions • Competitive compensation and benefits package