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5 дней назад

Pharmacist - Utilization Management (UM) - (Remote)

Формат работы
remote (только USA)
Тип работы
fulltime
Грейд
junior
Английский
b2
Страна
US
Вакансия из списка Hirify.GlobalВакансия из Hirify Global, списка международных tech-компаний
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Мэтч & Сопровод

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Описание вакансии

Текст:
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TL;DR
Pharmacist - Utilization Management (UM) - (Remote) (Prior Authorization/Appeals): Making medication coverage determinations by evaluating physician requests against medical policy criteria and conducting additional clinical research. Focus on reviewing complex coverage requests, updating utilization review records, and applying pharmacy knowledge to authorization and appeal decisions.

Location: Remote work from Pennsylvania, United States

Company

hirify.global provides health insurance and related healthcare services.

What you will do

  • Evaluate physician requests for medication coverage, prior authorization, and appeals against medical policy criteria.
  • Make coverage determinations using clinical pharmacy knowledge and the Utilization Review system.
  • Conduct research beyond medical policy review when needed to resolve coverage requests.
  • Update utilization review records to ensure claims are properly routed and paid.
  • Perform other assigned duties.

Requirements

  • Bachelor's degree in Pharmacy.
  • 1–3 years of pharmacy experience.
  • Registered Pharmacist license.
  • Communication, computer, problem-solving, decision-making, prioritization, and compliance skills.
  • Must work remotely from Pennsylvania, United States.

Culture & Benefits

  • Remote work arrangement.
  • Work involves protecting confidential customer and health information under HIPAA and company security policies.
  • Employment requires adherence to applicable laws, regulations, and the Code of Business Conduct.

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Jobs in the USA