Utilization Management Pharmacist – Temp, Temp-to-hire

📋 Description

• Evaluate and make prompt, evidence-based decisions regarding prior authorizations, appeals, and override requests by utilizing clinical guidelines and benefit criteria.

• Ensure adherence to federal, state, and internal regulations across Commercial, Exchange, Medicare, and Medicaid plans.

• Precisely document clinical decisions and maintain comprehensive records in line with regulatory and accreditation (URAC/NCQA) utilization review standards.

• Offer clear, empathetic assistance to members, prescribers, and pharmacies by addressing clinical inquiries via phone, showcasing professionalism, active listening, and a patient-focused approach.

• Remain updated on clinical prescribing guidelines, internal policies, and regulatory adjustments, applying them to daily tasks.

• Adhere to all internal processes, job aids, and HIPAA regulations to safeguard patient privacy and data security.

• Identify and report any potential fraud, waste, and abuse.

• Assist in the training and development of both new and existing team members as necessary.

• Support leadership with special projects, process enhancements, and operational initiatives.

⛳️ Requirements

• At least 6 months to a year of experience in prior authorization.

• Valid, unrestricted pharmacist license.

• Bachelor’s or Doctor of Pharmacy degree.

• Minimum of 2 years of experience in pharmacy practice.

• Background in managed care or pharmacy benefit management (PBM).

• Excellent communication, writing, and organizational skills.

• Capability to handle multiple priorities in a fast-paced, metric-driven environment.

• Willingness to work after hours, weekends, and holidays on a rotating basis.

🏝️ Benefits

• Comprehensive health insurance plans.

• Generous paid time off and holidays.

• Opportunities for professional development and continuing education.

• Retirement savings plans with company matching.