- Highmark Health (Bismarck, ND)
- …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
- CVS Health (Pittsburgh, PA)
- …will be responsible for overseeing the development, maintenance, and execution of utilization management programs. This will include both the clinical content ... needed to ensure the programs are implemented correctly. Knowledge of utilization management interventions including prior authorization, step therapy, quantity… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …as part of a core team. You'll collaborate cross-functionally with care management , utilization management , provider/member relations, and market-facing ... through our Healthsource blog: https://healthsource.premera.com/ . The **Senior Clinical Pharmacist ,** **Oncology Program** will lead and help develop Premera's… more
- Northwell Health (New Hyde Park, NY)
- …responsible for the development, implementation, and maintenance of drug formularies, clinical utilization management ( UM ) criteria, and evidence-based drug ... findings. + Performs all duties of a licensed registered Pharmacist as required by the leadership and as identified...in formulary management , P&T committee support, and/or utilization management (PA, ST, QL) criteria development… more