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Pharmacist Drug Utilization Review

9bjdnw2mlhip8doaz2t0q9w4wphk960418ms6mtfp5oxvgnr76bfafpnr8c62y27 · 30+ days ago

Rancho Cordova, CA, US

$156k+
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Full-time

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Pharmacist Drug Utilization Review

Location: Rancho Cordova, CA/Remote
Duration: 6 months with Possible Extension

Description:
Day to Day Responsibilities :
Using clients P&T approved clinical coverage criteria to review prior authorization requests for clinical appropriateness and medical necessity within the regulatory turnaround times.
Prior authorization requests are generally reviewed by pharmacy technicians first and approved when possible (following P&T approved coverage criteria).
Any potential denials of coverage require clinical review and sign-off by a pharmacist before a final denial decision is sent.
In addition, potential approvals for identified high-cost medications require a clinical review by a pharmacist to ensure P&T approved coverage criteria is correctly applied.

Required Skills (top 3 non-negotiables):
Agile Experience 2 Years minimum
Prior Authorization review experience (preferable) or managed care/PBM experience.
Thorough clinical knowledge regarding therapeutic use of drugs.
Familiarity with clinical compendia (Micromedex, Clinical Pharmacology, NCCN, AHFS, etc.) and proficiency with computers and software applications.

Preferred Skills (nice to have) :
Case Management Experience 3+ years
Completion of residency program (not strictly required)

Education Requirements: PharmD.

Software Skills Required: MS Outlook/Excel/Word

Required Certifications: A clear and unrestricted California State Board of Pharmacy RPH license

How many people are on your team Junior, Mid or Senior Level : 20 Pharmacists on the DUR Pharmacy Team, one DUR manager; one Sr. Manager

What other business units will this person interact with : Pharmacy Services teams; possible outreach to Drug Information Pharmacists when needed; Medical Director when needed; Formulary Team when needed; additional cross-functional support teams when needed. •

Last updated on Oct 20, 2023

About the company

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