WVU Medicine
10,000+ employees
âď¸ Healthcare Insurance
Healthcare Insurance
WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.
Clinical Utilization Management Pharmacist
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đ 3 days ago
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WVU Medicine
10,000+ employees
âď¸ Healthcare Insurance
Healthcare Insurance
WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.
đ Description
⢠Performing drug utilization review for initial determinations and/or appeals for ASO clients, Medicare Advantage plan, and any future lines of business. ⢠Collaborating as an integral member of the pharmacy team. ⢠Serving as a subject matter expert for pharmacy utilization management. ⢠Ensuring timely execution of all drug reviews in compliance with accreditation and regulatory standards. ⢠Working with the Medical Director and Clinical Formulary team to review specialty medications requiring a specialty consult. ⢠Identifying utilization review trends and areas of improvement.
đŻ 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.
đď¸ Benefits
⢠Standard office environment. ⢠Some travel may be required to offsite meetings.
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