Pharmacist - Utilization Management (UM) - Remote
Core
Reviews medication coverage requests for prior authorization and appeals by evaluating clinical information against medical policy criteria to determine coverage.
Role type
Utilization Management Pharmacist
Builds
Coverage determinations for medication requests
Domain
Healthcare / Pharmacy Benefit Management
Required skills
Clinical knowledge, Medical policy interpretation, Prior authorization evaluation, Appeals adjudication, System record updates, Medical research
Preferred skills
Doctorate degree in Pharmacy
Technologies
Utilization Review system
Responsibilities
Evaluate physician requests for prior authorization or appeals against medical policy; Conduct research beyond medical policy to make coverage decisions; Update system records to ensure proper claims routing and payment.
Seniority
Mid-level, hands-on IC
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