![Elevance Health](https://media.trabajo.org/img/noimg.jpg)
Pharmacist - Medicare Clinical Appeals
1 month ago
Please note: This is a virtual role where the successful hire will be located within 50 miles of a company office (PulsePoint) and may get asked to attend a town hall office meeting once a quarter.
Position specific details: The successful candidate will have experience with Medicare appeals and/or utilization review experience.
The Pharmacist – Clinical Appeals is responsible for managing the selection and utilization of pharmaceuticals and supports core clinical programs such as DUR.
Primary duties may include, but are not limited to:
-
Researches and synthesizes detailed clinical data related to pharmaceuticals.
-
May review and approve or deny coverage for pharmaceuticals (as permitted by state/federal law or state/federal program contracts) based on medical necessity criteria, and coordinates with Elevance Health or health plan medical directors as needed.
-
Serves as a clinical resource to other pharmacists on areas such as prospective and retrospective DURs and provides dosage conversion and clinical support for therapeutic interventions.
-
Prepares information for network physicians.
Position requirements:
-
Requires BA/BS in Pharmacy.
-
Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience; or any combination of education and experience, which would provide an equivalent background.
-
Requires a registered pharmacist.
-
Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh). PharmD preferred.
-
Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US, unless they are command-sanctioned activities.
-
For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Preferred qualifications:
-
Utilization management/review experience is strongly preferred.
-
Experience with Medicare is a plus.
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $112,000 to $201,600
Locations: Colorado; Hawaii; Nevada; New York; Washington State; Jersey City, NJ
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .
- The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
-
Clinical Pharmacist
3 weeks ago
Las Vegas, United States Sunrise Hospital Full timeDescription Hourly Wage Estimate: $58.33 - $75.83 / hourLearn more about the benefits offered for this job. The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in...
-
Clinical Pharmacist
2 weeks ago
Las Vegas, United States Sunrise Hospital Full timeDescription Hourly Wage Estimate: $58.33 - $75.83 / hour Learn more about the benefits offered for this job. The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already...
-
Clinical Pharmacist
5 hours ago
Las Vegas, Nevada, United States Sunrise Hospital Full timeSalary: $ $75.83 an hour Full-time Days (Rotating Weekends)Hourly Wage Estimate: $ $75.83/hourLearn more about the benefits offered for this job.The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and...
-
Clinical Pharmacist Emergency Dept
3 weeks ago
Las Vegas, United States Sunrise Hospital Full timeDescription Hourly Wage Estimate: $58.33 - $75.83 / hourLearn more about the benefits offered for this job. The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in...
-
Clinical Pharmacist Emergency Dept
3 weeks ago
Las Vegas, United States Sunrise Hospital Full timeDescription Hourly Wage Estimate: $58.33 - $75.83 / hour Learn more about the benefits offered for this job. The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already...
-
Utilization Management Pharmacist
1 month ago
Las Vegas, United States UnitedHealth Group Full timeFor those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. Under minimal supervision, the Clinical Pharmacist, Utilization Management (UM) for CO, NV, UT, AZ, or NM is responsible for...
-
Healthcare Services Pharmacist
2 days ago
Las Vegas, Nevada, United States Walgreens Full timeJob Description:Job Summary:Provides clinical services to patients, such as immunizations or MTM interventions, ensuring the compliance with regulatory guidelines, company policies and procedures.Job Responsibilities:Patient Experience Engages patients by greeting them and offering assistance with products and services. Resolves patient issues in a timely...
-
Fulfillment Staff Pharmacist
7 days ago
Las Vegas, Nevada, United States The Cigna Group Full timeThis is a full-time onsite Staff Fulfillment Pharmacist position at our Las Vegas, NV location. The shift for this position is Monday through Friday 8:00 am – 5 pm including 1-2 on call weekends per month.POSITION SUMMARYThe Staff Pharmacist interprets physicians' prescriptions, contacts doctors or other prescribers and/or patients to verify information on...
-
Clinical Staff Pharmacist Pharmacy
2 months ago
Las Cruces, United States Memorial Medical Center Full timeJob DescriptionWho We ArePeople are our passion and purpose. Come work where you are appreciated for who you are not just what you can do. Memorial Medical Center is a 199-bed hospital offering a spectrum of care, including diagnostic, therapeutic, and rehabilitative services, both on an inpatient and outpatient basis.Where We AreFrom national parks and...
-
Medical Biller Accounts Receivable Specialist
2 weeks ago
Las Vegas, United States Speakeasy Therapy Services, LLC Full timeJob DescriptionJob DescriptionWe are seeking a detailed-oriented and experienced Medical Biller to join our team. The Medical Biller will be responsible for working both insurance and patient AR, ensuring timely reimbursement from insurance companies, appealing and/or submitting for reconsideration of denied claims, maintaining current and correct insurance...
-
Pharmacist - Critical Care ICU
4 weeks ago
Las Vegas, United States Southern Hills Hospital and Medical Center Full timeDescription Hourly Wage Estimate: $64.16 - $83.41 / hourLearn more about the benefits offered for this job. The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in...
-
Las Vegas, United States Equity Staffing Group Full timeEquity Staffing Group is currently staffing a Pharmacist (Prior Authorization) for remote work in Illinois. This is contract work with a Fortune 100 organization. Our client serves more than 85 million people and has a reputation for bold ideas. If you enjoy working with energetic people in a collaborative environment, we want to speak with you!Position:...
-
Fulfillment Staff Pharmacist
2 days ago
Las Vegas, United States Cigna Full timeThis is a full-time onsite Staff Fulfillment Pharmacist position at our Las Vegas, NV location. The shift for this position is Monday through Friday 8:00 am - 5 pm including 1-2 on call weekends per month.POSITION SUMMARYThe Staff Pharmacist interprets physicians' prescriptions, contacts doctors or other prescribers and/or patients to verify information on...
-
Fulfillment Staff Pharmacist
5 days ago
Las Vegas, United States Cigna Full timeThis is a full-time onsite Staff Fulfillment Pharmacist position at our Las Vegas, NV location. The shift for this position is Monday through Friday 8:00 am - 5 pm including 1-2 on call weekends per month. POSITION SUMMARY The Staff Pharmacist interprets physicians' prescriptions, contacts doctors or other prescribers and/or patients to verify information...
-
Clinical Staff Pharmacist Pharmacy
3 weeks ago
Las Cruces, NM, United States Memorial Medical Center Full timeJob DescriptionWho We ArePeople are our passion and purpose. Come work where you are appreciated for who you are not just what you can do. Memorial Medical Center is a 199-bed hospital offering a spectrum of care, including diagnostic, therapeutic, and rehabilitative services, both on an inpatient and outpatient basis.Where We AreFrom national parks and...
-
Pharmacist
3 weeks ago
Las Cruces, United States MountainView Regional Medical Center Full timeMountainview Regional Medical Center has an opening for a Full Time Pharmacist - Emphasis in OncologyAs a Pharmacist at Mountainview Regional Medical Center, you'll play a vital role in doing what you do best- providing quality care to our patients. Our Lab staff enjoy a robust benefits package including health insurance, 401K, flexible scheduling.The...
-
Pharmacist
2 weeks ago
Las Cruces, United States MountainView Regional Medical Center Full timeMountainview Regional Medical Center has an opening for a Full Time Pharmacist - Emphasis in OncologyAs a Pharmacist at Mountainview Regional Medical Center, you'll play a vital role in doing what you do best- providing quality care to our patients. Our Lab staff enjoy a robust benefits package including health insurance, 401K, flexible scheduling.The...
-
Pharmacist
3 weeks ago
Las Cruces, United States MountainView Regional Medical Center Full timeMountainview Regional Medical Center has an opening for a Full Time Pharmacist - Emphasis in Oncology As a Pharmacist at Mountainview Regional Medical Center, you'll play a vital role in doing what you do best- providing quality care to our patients. Our Lab staff enjoy a robust benefits package including health insurance, 401K, flexible scheduling. The...
-
Pharmacist
4 days ago
Las Cruces, United States MountainView Regional Medical Center Full timeMountainview Regional Medical Center has an opening for a Full Time Pharmacist - Emphasis in Oncology As a Pharmacist at Mountainview Regional Medical Center, you'll play a vital role in doing what you do best- providing quality care to our patients. Our Lab staff enjoy a robust benefits package including health insurance, 401K, flexible scheduling. The...
-
Clinical Documentation Coordinator
2 months ago
Las Vegas, United States MNCP Staffing Full timeJob DescriptionJob DescriptionMy Next Career Path Staffing - With over 20 years’ experience in Technology Staffing, MNCP Staffing matches candidates to the culture of an organization as well as required skill sets Position Summary:Responsible for improving the overall quality and completeness of clinical documentation. Facilitates modifications to clinical...