Clinical UM Pharmacist
6 days ago
Job Title: Clinical UM Pharmacist - Specialty Medications and Billing Expert
Overview: We are seeking a highly skilled Clinical UM Pharmacist to join our team at Lifelancer, a talent-hiring platform in Life Sciences, Pharma and IT. As a key member of our Utilization Management team, you will play a vital role in reviewing prior authorizations for medications under the medical benefit.
Responsibilities:
- Monitor and review prior authorization requests for specialty medications
- Calculate billable units based on dosing, indication, weight, BMI, and other clinical considerations
- Develop and maintain clinical criteria and medical policies for medication reviews
- Ensure compliance with regulations from CMS and NYSDOH
- Stay current with literature, evidence-based medicine, and trends in medicine
- Collaborate with physicians and Medical Directors to discuss clinical rationale for review decisions
- Review monthly reports and provide feedback on trends, efficiency, and innovation
Requirements:
- Pharmacy degree from an accredited school of pharmacy
- Registered Pharmacist with a state license in good standing
- Experience conducting prior authorization reviews
- Clinical knowledge of pharmaceuticals and disease states
- Excellent written and verbal communication skills
Preferred Qualifications:
- PGY1 Managed Care Residency
- Knowledge of CMS regulations and National and Local Coverage Determinations
- Demonstrated critical thinking and problem-solving skills
- Passion for learning and growing skills in a dynamic environment
Benefits:
- Competitive salary range: $86,500 - $128,690 (dependent on location)
- A comprehensive benefits package, including medical, dental, and vision coverage
- Incentive and recognition programs
- 401k contributions
Lifelancer Overview: We believe in providing a competitive compensation and benefits package wherever our employees work and live. Our hiring range is defined as the lowest and highest salaries that we would pay to a new hire or for a job promotion or transfer into this role.
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