Pharmacist Reimbursement Specialist

20 hours ago

Coral Gables, Florida, United States InsideHigherEd Full time
Job Summary:

The University of Miami Hospital and Clinics Sylvester Cancer Center is seeking a highly skilled Pharmacist Reimbursement Analyst to join our team. As a key member of our pharmacy team, you will be responsible for performing clinical and financial analysis functions to ensure appropriate, safe, and cost-effective utilization of oncology and non-oncology therapy.

Key Responsibilities:
  • Collaborate with the Utilization Review Department and providers to ensure clinically appropriate, safe, and cost-effective use of oncology treatment regimens.
  • Support system-wide formulary management, including performing cost-benefit analysis of formulary considerations.
  • Perform continuous medication maintenance to ensure appropriate third-party billing, including updates to HCPCS/CPT codes and validation of billing mechanisms to ensure alignment with federal and state regulatory requirements.
  • Conduct periodic Medication Use Evaluations (MUE) reviews to assess appropriate utilization and cost-effectiveness of oncology and non-oncology agents and optimize use accordingly.
  • Participate in Pharmacy and Therapeutics Committee and other departmental subcommittees.
  • Ensure Revenue Integrity optimization through active Pharmacy participation and initiatives to support system growth.
  • Complete regular systemic medication audits to identify trends and create mitigation strategies to improve processes leading to suboptimal reimbursement.
  • Manage system-wide manufacturer-driven medication Patient Assistance Program (mPAP) for facility-administered oncology and non-oncology treatments for uninsured and underinsured patients.
  • Maintain oversight of all medication Patient Assistance Program inventory and records, ensuring compliance with program rules and requirements.
  • Supervise Pharmacy Patient Assistance Technicians and precept pharmacy students and PGY-1/2 residents.
Requirements:
  • Current licensure in good standing in the State of Florida and a degree in Pharmacy from an accredited College of Pharmacy.
  • PharmD required; consideration given to candidates who have been grandfathered by the state of Florida to keep their licenses active/current if obtained before changes to the Pharmacists' licenses (PharmD requirement) took place.
  • Previous hospital experience preferred.
  • Previous oncology experience beneficial, although not required.
  • Prior manager or supervisor experience preferred.
  • Must possess good organizational, problem-solving, and computer skills.
  • Strong written and verbal communication skills required for interacting with all levels of UMHC staff, physicians, and others.
About the University of Miami:

The University of Miami offers competitive salaries and a comprehensive benefits package, including medical, dental, tuition remission, and more. As an academic medical center, we are proud to serve South Florida, Latin America, and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. We're the challenge you've been looking for.

The University of Miami is an Equal Opportunity Employer - Females/Minorities/Protected Veterans/Individuals with Disabilities are encouraged to apply. Applicants and employees are protected from discrimination based on certain categories protected by Federal law.

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