Pharmacist - Utilization Management (UM)- REMOTE
Company: Highmark Health
Location: Topeka
Posted on: June 22, 2022
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Job Description:
**Company :** Highmark Inc. **Job Description :** **JOB
SUMMARY** This job reviews requests for medication coverage
determination for prior authorization review and appeals. Through
the Utilization Review system, the incumbent evaluates clinical
information provided by the physician against medical policy
criteria. The incumbent then uses his/her clinical knowledge
compared to the policy and physician request to make a
determination. At times, the incumbent may conduct additional
research beyond medical policy review to make coverage
determinations. **ESSENTIAL RESPONSIBILITIES** + Make coverage
determinations by evaluating physician requests for prior
authorization or appeals against medical policy through the
Utilization Review system. Update the system records appropriately
to ensure claims are properly routed and paid. + Conduct research
beyond medical policy review to make decisions on medication
coverage requests. + Other duties as assigned. **EDUCATION**
**Required** + Bachelor's degree in Pharmacy **Substitutions** +
None **Preferred** + Doctorate degree in Pharmacy **EXPERIENCE**
**Required** + 1 - 3 years in Pharmacy **Preferred** + None
**LICENSES OR CERTIFICATIONS** **Required** + Registered Pharmacist
Preferred + None **SKILLS** + Oral & Written Communication Skills +
General Computer Skills + Problem Solving & Decision Making +
Compliance + Prioritizing **Language Requirement (other than
English)** None **Travel Required** None **PHYSICAL, MENTAL DEMANDS
and WORKING CONDITIONS** **Position Type** Office-Based Teaches /
trains others regularly Occasionally Travel regularly from the
office to various work sites or from site-to-site Rarely Works
primarily out-of-the office selling products/services (sales
employees) Never Physical work site required Yes Lifting: up to 10
pounds Constantly Lifting: 10 to 25 pounds Rarely Lifting: 25 to 50
pounds Rarely **_Disclaimer:_** _The job description has been
designed to indicate the general nature and essential duties and
responsibilities of work performed by employees within this job
title. It may not contain a comprehensive inventory of all duties,
responsibilities, and qualifications required of employees to do
this job._ **_Compliance Requirement_** _: This job adheres to the
ethical and legal standards and behavioral expectations as set
forth in the code of business conduct and company policies._ _As a
component of job responsibilities, employees may have access to
covered information, cardholder data, or other confidential
customer information that must be protected at all times. In
connection with this, all employees must comply with both the
Health Insurance Portability Accountability Act of 1996 (HIPAA) as
described in the Notice of Privacy Practices and Privacy Policies
and Procedures as well as all data security guidelines established
within the Company's Handbook of Privacy Policies and Practices and
Information Security Policy._ _Furthermore, it is every employee's
responsibility to comply with the company's Code of Business
Conduct. This includes but is not limited to adherence to
applicable federal and state laws, rules, and regulations as well
as company policies and training requirements._ Highmark Health and
its affiliates prohibit discrimination against qualified
individuals based on their status as protected veterans or
individuals with disabilities, and prohibit discrimination against
all individuals based on their race, color, religion, sex, national
origin, sexual orientation/gender identity or any other category
protected by applicable federal, state or local law. Highmark
Health and its affiliates take affirmative action to employ and
advance in employment individuals without regard to race, color,
religion, sex, national origin, sexual orientation/gender identity,
protected veteran status or disability. Highmark Health and its
affiliates prohibit discrimination against qualified individuals
based on their status as protected veterans or individuals with
disabilities, and prohibit discrimination against all individuals
based on their race, color, age, religion, sex, national origin,
sexual orientation/gender identity or any other category protected
by applicable federal, state or local law. Highmark Health and its
affiliates take affirmative action to employ and advance in
employment individuals without regard to race, color, age,
religion, sex, national origin, sexual orientation/gender identity,
protected veteran status or disability. EEO is The Law Equal
Opportunity Employer Minorities/Women/Protected
Veterans/Disabled/Sexual Orientation/Gender Identity ( _) We
endeavor to make this site accessible to any and all users. If you
would like to contact us regarding the accessibility of our website
or need assistance completing the application process, please
contact number below. For accommodation requests, please contact HR
Services Online at HRServices@ California Consumer Privacy Act
Employees, Contractors, and Applicants Notice Req ID: J208091
Keywords: Highmark Health, Topeka , Pharmacist - Utilization Management (UM)- REMOTE, Executive , Topeka, Kansas
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