Clinical Pharmacist, Utilization Management Specialist
2 weeks ago
At Rightway Inc, we are seeking a highly skilled Clinical Pharmacist to join our Utilization Management team. As a key member of our Clinical Operations team, you will play a critical role in delivering our Utilization Management strategy and actively working UM cases.
Key Responsibilities- Support all lines of business by reviewing utilization management requests for coverage that are clinically appropriate and cost-effective.
- Continually review UM operational processes to ensure effective and compliant delivery of PBM services to our clients.
- Coordinate with Pharmacy technicians, Pharmacists, and/or Medical Directors on UM activities.
- Ensure cases are reviewed in accordance with State and/or Federal guidelines, including turnaround time requirements.
- Discuss clinical strategy and decision rationale with prescribers as needed.
- Participate in the quality review and inter-rater reliability processes.
- Support the P&T process, including the development of therapeutic class/drug monographs as needed.
- Research and develop therapy-specific clinical policies and utilization management programs, such as Prior Authorization, Step Therapy, Quantity Limit, and/or Coverage Determination programs.
- Support Clinical Operations leadership and coordinate with the Pharmacy Navigation team as needed.
- Pharmacy Degree Required, PharmD preferred.
- 1 year experience coordinating medication selection with prescribers and their care teams. Preferred: 1-3+ years of managed care (PBM or health plan) prior authorization experience.
- Pharmacist license in good standing in the state of residence. Willingness to achieve and maintain licensure in multiple states (if needed).
- Available to work 40 hours/week. Core operating hours are weekdays within 8 am Eastern Time and 8 pm Eastern Time, but may be required to work evening and/or weekend shifts in the future as Rightway grows. On call approximately once every two months.
Rightway Inc is on a mission to harmonize healthcare for everyone, everywhere. Our products guide patients to the best care and medications by inserting clinicians and pharmacists into a patient's care journey through a modern, mobile app. Rightway is a front door to healthcare, giving patients the tools they need along with on-demand access to Rightway health guides, human experts that answer their questions and manage the frustrating parts of healthcare for them.
Since its founding in 2017, Rightway has raised over $130mm from investors, including Khosla Ventures, Thrive Capital, and Tiger Global, at a valuation of $1 billion. We're headquartered in New York City, with a satellite office in Denver. Our clients rely on us to transform the healthcare experience, improve outcomes for their teams, and decrease their healthcare costs.
We're seeking those with passion for healthcare and relentless devotion to our goal. We need team members who will:
- Be human first - Our humanity binds us together. We bring the same empathetic approach to every individual we engage with, whether it be our members, our clients, or each other.
- Redefine what is possible - We always look beyond the obstacles in front of us to imagine new solutions.
- Debate then commit - We believe that a spirit of open discourse is part of a healthy culture.
- Cultivate grit - Changing healthcare doesn't happen overnight. We reflect and learn from challenges and approach the future with a determination to strive for better.
- Seek to delight - Healthcare is complicated and personal. We work tirelessly to meet the goals of our clients while also delivering the best experience to our members.
We are PROUDLY an Equal Opportunity Employer that believes in strength in the diversity of thought processes, beliefs, background, and education and fosters an inclusive culture where differences are celebrated to drive the best business decisions possible. We do not discriminate on any basis covered by appropriate law. All employment is decided on the consideration of merit, qualifications, need, and performance.
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Dallas, Texas, United States Rightway Inc Full timeAbout the RoleRightway Inc. is seeking a highly skilled Clinical Pharmacist to join our Pharmacy Benefit Management (PBM) team. As a key member of our Clinical Operations team, you will play a critical role in delivering our PBM strategy and actively working on utilization management cases.Key ResponsibilitiesSupport all lines of business by reviewing...
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