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Clinical Pharmacist

1 month ago

Denver, Colorado, United States UnitedHealth Group Full time
Job Summary

We are seeking a highly skilled Clinical Pharmacist to join our team in Utilization Management. As a key member of our team, you will be responsible for ensuring the effective management of medication utilization and prior authorization requests for value-based patients in the Optum West region.

Key Responsibilities
  • Collaborate with the Pharmacy and Regional Leadership to implement, evaluate, and optimize national, regional, and local pharmacy and medication utilization initiatives.
  • Provide timely review of value-based patients by processing prior authorization and medical necessity requests for specialty ambulatory injectable and/or infusion medications.
  • Assist with alternate sites of services for medications as needed.
  • Review specialty medication prior authorization requests according to established treatment protocols, clinical criteria, and member benefits.
  • Make authorization determinations within defined turnaround times and meet regulatory requirements.
  • Participate in ongoing reviews of medication policies and procedures, protocols, guidelines, and tools to improve utilization management.
  • Assist with the development of resources to align various levels of clinical pharmacy services to local and regional medication utilization initiatives.
Requirements
  • PharmD degree.
  • Current WA, OR, CO, NV, UT, AZ, or NM Pharmacist License, unrestricted.
  • Willing to pursue licensure in additional states: WA, OR, CO, NV, UT, AZ, or NM.
  • 3+ years clinical pharmacy and/or clinical health plan experience in working with physicians and other healthcare professionals.
  • Proficient in Microsoft Office Suite - Outlook, Word, Excel.
Preferred Qualifications
  • AZ Unrestricted Pharmacist License.
  • CO Unrestricted Pharmacist License.
  • NM Unrestricted Pharmacist License.
  • NV Unrestricted Pharmacist License.
  • UT Unrestricted Pharmacist License.
  • WA Unrestricted Pharmacist License.
  • OR Unrestricted Pharmacist License.
  • 1+ years of experience in Oncology Setting.
  • Knowledge and understanding of NCQA Guidelines.
  • Knowledge of Medicare, Medicaid, and commercial payor guidelines.
  • Knowledge clinical evidence resources for use in individual case research.
  • Knowledge of Managed care concepts and utilization management principles.