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Clinical Utilization Management Pharmacist
WVU Medicine. Perform drug utilization review for initial determinations and/or appeals for ASO clients and Medicare Advantage plan.
About the role
Key responsibilities & impact- Perform drug utilization review for initial determinations and/or appeals for ASO clients and Medicare Advantage plan.
- Collaborate as an integral member of the pharmacy team.
- Serve as subject matter expert for pharmacy utilization management.
- Ensure timely execution of all drug reviews in compliance with accreditation and regulatory standards.
- Work with Medical Director and Clinical Formulary team to review specialty medications requiring a consult.
Requirements
What you’ll need- 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
Comp & perks- Standard office environment
- Some travel may be required to offsite meetings
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
drug utilization reviewclinical pharmacymanaged carespecialty medicationspharmacy utilization management
Soft Skills
collaborationsubject matter expertisetimely execution
Certifications
pharmacy license