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Pharmacist
PharmacistThe Judge Group • United States
Pharmacist

Pharmacist

The Judge Group • United States
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About the Company

Our client is currently seeking a Licensed Pharmacist.

About the Role

Regulatory requirements to utilize a US based and US licensed resource to conduct UM reviews. US licensed Pharmacist with minimum of 3-5 years health plan experience and the Utilization Management / Prior Authorization experience required to be able to conduct clinical reviews of medical benefit and pharmacy drug reviews and issue either an approval or a recommendation to deny with supporting rationale for final decision by the health plan's MD. Provide clinical review and support of payer's pharmacy clinical policies.

Responsibilities

  • Conduct clinical reviews of medical benefit and pharmacy drug reviews.
  • Issue either an approval or a recommendation to deny with supporting rationale for final decision by the health plan's MD.
  • Provide clinical review and support of payer's pharmacy clinical policies.

Qualifications

  • US licensed Pharmacist with minimum of 3-5 years health plan experience.

    • Required Skills

  • Minimum of 3-5 years health insurance plan experience.
  • Minimum of 3-5 years conducting utilization management reviews for medical and pharmacy prior authorization requests.
  • Experience with reviewing and providing input into clinical pharmacy policies that define criteria required to support payer coverage decisions.
  • Minimum of 5 years’ experience with Microsoft applications (Word, PowerPoint, Excel, etc.).

    • Preferred Skills

  • Ability to work independently.
  • Experience working in electronic medical records (EMR) systems.

    • Pay range and compensation package

    Rate : 60 / hr

    Preferred Start Date : 11 / 03 / 2025

    Duration : 3 months

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    Pharmacist • United States