Clinical UM Pharmacist

3 weeks ago


New York, New York, United States Health First Full time
Job Summary

Health First is seeking a skilled Clinical UM Pharmacist to join our team. As a key member of our Utilization Management department, you will play a critical role in ensuring the efficient and effective review of medication requests.

Key Responsibilities

Monitor and review prior authorization requests for medications to ensure compliance with regulatory requirements

Calculate appropriate billable units based on dosing, indication, weight, BMI, and other clinical considerations

Develop clinical criteria and medical policies for the review of medications, ensuring alignment with CMS and NYSDOH guidelines

Conduct research to maintain drug knowledge and disease state understanding for application to prior authorization reviews

Collaborate with cross-functional teams to complete Utilization Management reviews and ensure timely completion of prior authorization reviews

Analyze monthly reports to identify trends, opportunities for efficiency, and areas for innovation

Requirements

Pharmacy degree from an accredited school of pharmacy

Registered Pharmacist with a state license in good standing

Experience conducting prior authorization reviews and clinical knowledge of pharmaceuticals and disease states

Excellent written and verbal communication skills, with the ability to communicate complex information clearly and concisely

Preferred Qualifications

PGY1 Managed Care Residency

Knowledge of regulations, including National and Local Coverage Determinations

Demonstrated critical thinking and problem-solving skills, with a passion for learning and growth

Experience leading working meetings and proficiency in Microsoft Office applications

Regulatory Compliance

As a Clinical UM Pharmacist, you will assist in regulatory and compliance audits for all plans, ensuring all activities are conducted in compliance with regulations. Health First is an equal opportunity employer and welcomes applications from diverse candidates.
  • Clinical Pharmacist

    4 weeks ago


    New York, New York, United States Health First Full time

    Job SummaryWe are seeking a highly skilled Clinical Pharmacist to join our team as a UM Reviewer. As a key member of our Utilization Management team, you will be responsible for reviewing and approving medication requests, ensuring compliance with regulatory requirements, and developing clinical criteria and medical policies.Key ResponsibilitiesReview and...

  • Clinical Pharmacist

    4 weeks ago


    New York, New York, United States ChristianaCare Full time

    ChristianaCare Clinical Pharmacist OpportunityWe are seeking a skilled Clinical Pharmacist to join our team in the Ambulatory Anticoagulation Clinics. This role will involve working approximately one to two 8-hour shifts bi-weekly, with potential coverage in other clinics as needed.Key Responsibilities:Evaluate drug efficacy and monitor therapeutic goals and...

  • Clinical Pharmacist

    4 weeks ago


    New York, New York, United States ChristianaCare Full time

    Unlock Your Potential as a Clinical Staff Pharmacist at ChristianaCareAre you a skilled pharmacist looking to make a meaningful impact in the healthcare industry? Do you want to work for a leading health system that values pharmacy services and prioritizes patient care? Look no further than ChristianaCare, one of the country's most dynamic health...


  • New York, New York, United States WelbeHealth Full time

    Job SummaryWe are seeking a highly skilled Clinical Pharmacist to join our team at WelbeHealth. As a Clinical Pharmacist, you will play a vital role in providing comprehensive pharmaceutical care to our patients.Key ResponsibilitiesConduct comprehensive medication reviews to identify drug therapy issues, interactions, and opportunitiesProvide clinical...


  • New York, New York, United States destinationone Consulting Full time

    Destinationone Consulting: Clinical Pharmacist OpportunityWe are seeking a highly skilled Clinical Pharmacist to join our team at destinationone Consulting. As a Clinical Pharmacist, you will play a critical role in providing direct patient care through medication management and collaborating with healthcare teams to optimize therapeutic outcomes.Key...


  • New York, New York, United States SUNY Downstate Health Sciences University Full time

    Ambulatory Care Clinical PharmacistSUNY Downstate Health Sciences University is seeking a full-time Ambulatory Care Clinical Pharmacist to provide pharmacy services for patients in adult outpatient clinics.The ideal candidate will have a Doctorate of Pharmacy (PharmD) from an accredited College of Pharmacy and New York State Pharmacist Licensure or...


  • New York, New York, United States AtlantiCare Full time

    About the JobThe Pharmacist in this role will be responsible for ensuring accurate and timely medication distribution and other pharmaceutical supplies according to established procedures and standards. This will be in support of high-quality patient care at AtlantiCare's Anticoagulation Clinic.As a Pharmacist, you will interpret, evaluate and verify...


  • New York, New York, United States Memorial Sloan Full time

    Exciting Opportunity at Memorial Sloan Kettering:We are seeking a highly skilled Floater Pharmacist to join our team at the Main Campus Hospital.Role Overview:The successful candidate will serve as a fully integrated member of the Pharmacy Department, providing advanced clinical pharmacy services to patients.Key Responsibilities:Provide expert clinical...


  • New York, New York, United States AIDS Healthcare Foundation Full time

    Key Responsibilities:Contribute to the expansion of primary care functions of pharmacy in clinical settings.Collaborate with healthcare teams to provide high-quality patient care.Develop and implement clinical pharmacy services to improve patient outcomes.Participate in the development and implementation of practice guidelines and policies.About the Role:A...


  • New York, New York, United States ABD RxCare Inc Full time

    At ABD RxCare Inc, we are seeking a highly skilled Senior Clinical Pharmacist Leader to join our team on an as-needed basis.Job Summary:We are looking for a seasoned pharmacist with exceptional leadership skills and clinical expertise to oversee the dispensing of medications prescribed by physicians and other healthcare...


  • New York, New York, United States CVS Health Full time

    Job SummaryCVS Health is seeking a highly skilled and dedicated Pharmacist to join our team. As a key member of our pharmacy team, you will play a critical role in delivering exceptional patient care and ensuring the highest level of quality and safety in our pharmacies.Key ResponsibilitiesProvide clinical guidance and support to patients and healthcare...

  • Clinical Pharmacist

    3 weeks ago


    New York, New York, United States AIDS Healthcare Foundation Full time

    About the RoleAIDS Healthcare Foundation is seeking a highly skilled Clinical Pharmacist to join our team. As a Clinical Pharmacist, you will contribute to the delivery of high-quality patient care and play a key role in expanding primary care functions of pharmacists.Key ResponsibilitiesProvide individualized health promotion and disease prevention...

  • Clinical Pharmacist

    3 weeks ago


    New York, New York, United States US Tech Solutions Full time

    Job Summary:The clinical pharmacist is a key role in our organization, responsible for conducting clinical reviews of medical data to perform prior authorization for specialty medications. This position requires the application of clinical knowledge to plan approved criteria for prospective and concurrent reviews of cases.The clinical pharmacist will...

  • Clinical Pharmacist

    3 weeks ago


    New York, New York, United States Rite Aid Full time

    Job SummaryThe Clinical Pharmacist position is responsible for providing clinical support to customers through all clinical programs offered to our customers, including adherence, immunizations, and MTM interventions.This position is responsible for ensuring compliance with regulatory guidelines, company policies, and procedures.ResponsibilitiesSupport...

  • Clinical Pharmacist

    4 weeks ago


    New York, New York, United States US Tech Solutions Full time

    Job Summary:The Clinical Pharmacist will conduct clinical reviews of medical data to perform prior authorization for specialty medications. This role requires a strong understanding of clinical knowledge to plan approved criteria for prospective and concurrent reviews of cases.The Clinical Pharmacist will collaborate with the CRU Technician to process...


  • New York, New York, United States Capital Rx Full time

    Job SummaryWe are seeking a highly skilled Pharmacist to join our team as a Clinical Coverage Determination Specialist. In this role, you will be responsible for reviewing clinical coverage determinations and appeals for different lines of business, including Commercial and Medicare.Key ResponsibilitiesEvaluate and review all appeals requests to render...


  • New York, New York, United States Walgreens Full time

    Job SummaryWe are seeking a highly skilled and compassionate Pharmacist (Full or Part Time) to join our team at Walgreens. As a key member of our healthcare team, you will be responsible for providing exceptional patient care and clinical expertise in a fast-paced retail pharmacy environment.Key ResponsibilitiesProvide accurate and timely dispensing of...


  • New York, New York, United States ChristianaCare Full time

    Pharmacist Opportunity at ChristianaCareWe are seeking a highly skilled and experienced Pharmacist to join our team at ChristianaCare, a leading healthcare provider in the nation. As a Pharmacist at ChristianaCare, you will play a critical role in ensuring the safe and effective use of medications for our patients.Key Responsibilities:Dispense medications...


  • New York, New York, United States Mason Rx Inc Full time

    Job SummaryWe are seeking a highly skilled Senior Clinical Pharmacist to oversee the dispensing of medications and provide expert advice to healthcare professionals.Key Responsibilities:Compound and dispense prescribed medications with precision and accuracyProvide in-depth guidance to physicians and health practitioners on medication interactions and side...


  • New York, New York, United States Capital Rx Full time

    Job Summary:Capital Rx is seeking a skilled Clinical Pharmacist to join our team in reviewing clinical coverage determinations and appeals for various lines of business, including Commercial and Medicare. As a Clinical Pharmacist, you will be responsible for evaluating and reviewing appeals requests, rendering coverage determinations based on clinical...