- Highmark Health (Providence, RI)
- …coverage determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure claims… more
- Point32Health (Canton, MA)
- …. **Job Summary** Under the direction of the Pharmacy Utilization Management ( UM ) Supervisor, the Clinical Pharmacist is responsible for ... issues with pharmacy technicians and confer with other clinical pharmacist on review questions + Communicate with UM... pharmacist on review questions + Communicate with UM staff and providers when issues arise regarding policy… more