Highmark Health
Pharmacist - Utilization Management (UM) Remote
Highmark Health, Boise, Idaho, United States, 83708
JOB SUMMARY
This role reviews medication coverage determinations for prior authorization requests and appeals. The incumbent evaluates clinical information against medical policy criteria using the Utilization Review system, then makes coverage determinations and routes claims appropriately.
ESSENTIAL RESPONSIBILITIES
Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records to ensure claims are routed and paid.
Conduct research beyond medical policy review to decide on medication coverage requests.
Other duties as assigned.
EDUCATION
Bachelor's degree in Pharmacy
EXPERIENCE
1 - 3 years in Pharmacy
LICENSES OR CERTIFICATIONS
Registered Pharmacist
SKILLS
Oral & Written Communication Skills
General Computer Skills
Problem Solving & Decision Making
Compliance
Prioritizing
Language Requirement None
Travel Required None
Pay Range Minimum $67,500.00
Pay Range Maximum $126,000.00
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
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ESSENTIAL RESPONSIBILITIES
Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records to ensure claims are routed and paid.
Conduct research beyond medical policy review to decide on medication coverage requests.
Other duties as assigned.
EDUCATION
Bachelor's degree in Pharmacy
EXPERIENCE
1 - 3 years in Pharmacy
LICENSES OR CERTIFICATIONS
Registered Pharmacist
SKILLS
Oral & Written Communication Skills
General Computer Skills
Problem Solving & Decision Making
Compliance
Prioritizing
Language Requirement None
Travel Required None
Pay Range Minimum $67,500.00
Pay Range Maximum $126,000.00
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
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