**Overview:**
The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical necessity and comprehensive medication reviews for prescriptions requiring prior authorization. This role involves evaluating complex clinical scenarios and applying evidence-based criteria to ensure appropriate medication use. **Responsibilities:**
• Conduct medical necessity and comprehensive medication reviews for prescriptions requiring prior authorization
• Evaluate complex clinical scenarios and apply evidence-based criteria to ensure appropriate medication use
• Address moderately complex to complex issues that require critical thinking and in-depth analysis of variable factors
• Intervene and provide clinical guidance to patients and providers to support cost-effective medication use and promote high-quality patient outcomes
• Identify unusual usage patterns and analyze overall utilization to support optimal medication use
• *Qualifications:**
• Bachelor's degree or Doctor of Pharmacy (Pharm.D.) from an accredited college of pharmacy
• Active pharmacist license in the state of residence
• Eligibility to participate in federal prescription programs (e.g., Medicare/Medicaid)
• Self-directed with the ability to work effectively both independently and in a team environment
• Strong problem-solving skills and the ability to foster collaborative solutions
• High attention to detail with a strong work ethic focused on accuracy and productivity
• Excellent verbal and written communication skills
• Proficiency with computer systems, including but not limited to:
+ Microsoft Office Suite (Word, Excel, Outlook)
+ Clinical decision support tools (e.g., Micromedex, Lexicomp)
+ Pharmacy benefit management (PBM) platforms
+ Electronic health records (EHRs)
• *Benefits:**
• Competitive salary range: $104,000 - $143,000 per year
• Bonuses and incentives
• Comprehensive medical, dental, and vision benefits
• 401(k) retirement savings plan
• Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• Short-term and long-term disability
• Life insurance
• And many other opportunities to support whole-person well-being
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