- Molina Healthcare (Orlando, FL)
- … (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management ), clinical pharmacy ... patient outcomes, medications safety and medication use policies). **KNOWLEDGE/SKILLS/ABILITIES** The Pharmacist , UM will be responsible for reviewing coverage… more
- CVS Health (Pittsburgh, PA)
- …Insurance Audits and Market Checks** + Ensure template formularies design and application of utilization management ( UM ) criteria align with MHPAEA and other ... and sign-off on audit responses and corrective action plans. ** Utilization Management ** + Understand UM ...+ PharmD or equivalent clinical pharmacy degree. + Active pharmacist license in good standing. + Ability and willingness… more
- CVS Health (Providence, RI)
- …long-term vision and strategy around Part B drug management related to utilization management ( UM ), clinical programs, and pharmacy operations. + Lead ... every day. As the Senior Manager, Aetna Medicare Medical Pharmacist , you will play a key role in the...B and specialty drugs. Key areas of responsibility include utilization management , clinical programs, and operational excellence.… more
- Prime Therapeutics (Lansing, MI)
- …evaluation for coverage determination requests for prior authorization (PA) or other utilization management ( UM ) programs, including quantity limits, step ... Pharmacist is responsible for the processing and documenting of Utilization Management requests (ie formulary exceptions, prior authorization, step therapy,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …of consistent and quality health care services. Examples may include: Utilization Management , Quality, Behavioral Health, Pharmacy, Registered Dietitian and ... within the group. + Responsible for all aspects of the Case Management department functions including quality, productivity, utilization performance, and… more
- US Tech Solutions (May, OK)
- …work experience (healthcare or call center preferred). + Prior experience with utilization management or prior authorization processes preferred. **Licensure** + ... **Duration: 06 months contract** **Position Summary** + The UM Nurse Associate I is responsible for reviewing...services, and refers cases requiring clinical review to the Pharmacist or MD team. **Duties** + Answer inbound nurse… more
- Highmark Health (Wexford, PA)
- …with all regulatory agency requirements **ESSENTIAL RESPONSIBILITIES** + Reviews pharmacy utilization management ( UM ) coverage requests and prepares ... such cases for clinical review by a pharmacist and/or medical director when required. (20%) + Within...+ May perform other non-clinical duties as required by management and department needs. **QUALIFICATIONS** **Required** + 2 years… more