Description
Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm)
Under general supervision of the Speciality Drug Review (SDR) Director of Clinical Pharmacy, the SDR Clinical Pharmacist is responsible for completing prior authorization functions as needed for WellMed Managed Care Patients. The Clinical Pharmacist will also work with SDR nurses, Care Team Associates (CTAs) and the Enterprise Care& Value Pharmacy & Therapeutics Committee. This pharmacist will primarily be conducting prior authorization reviews on Part B specialty medications and Oncology medications; assist with criteria development and preferably, should have a working knowledge of Medicare rules and regulations.
Primary Responsibilities:
* Completes assigned daily cases to meet production and performance metrics as determined by the department in order to comply with CMS Part B turnaround times (TAT)
* Provide timely review for WellMed members by processing prior authorization and medical necessity requests for specialty CMS part B medications
* Review specialty medication prior authorization requests (i.e. biopharmaceuticals) according to established treatment protocols, clinical criteria and member benefits and make determinations within the defined turnaround times to meet regulatory requirements
* Knowledgeable of current and emerging clinical trends
* Active participation in various clinical departmental meetings and forums to improve clinical programs, enhance processes, and share clinical information
* Continuously look for ways to streamline and improve workflow
* Assist with user acceptance testing for new clinical programs and system enhancements
* Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practice specific to specialty pharmacy
* Serves as a clinical resource and consultant in all areas of pharmacy and medication management for members, patients, providers, internal departments, and/or external third parties
* Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
* Supports overall Enterprise Care &Value department initiatives
* Follow all policies and procedures related to job
* Performs all other related duties as assigned to meet departmental objectives
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
* Doctor of Pharmacy degree
* Current Pharmacist license to practice in the applicable state or the ability to provide proof of licensure within 90 days from date of employment
* 2+ years of experience as a Prior Authorization Pharmacist or Clinical Pharmacist
* Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance
Preferred Qualifications:
* Board certification by the Board of Pharmacy Specialties (BPS)
* Certified Geriatric Pharmacist
* Certification in Medication Therapy Management (MTM)
* Experience with Medicare guidelines
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Comprehensive Review, DUR, Oncology, Specialty Pharmacy, Part B, Clinical Pharmacist, Utilization Management, UM, SDR, San Antonio, TX, Texas
