Managed Care Pharmacist - Medical Benefit Utilization Management - Remote

Department:

Status:

Benefits Eligible:

Hours Per Week:

Schedule Details/Additional Information:

Monday to Friday, regular business hours. Remote position.

MAJOR RESPONSIBILITIES

Develops competency in basic principles of payer reimbursement strategy and pharmacy utilization management under delegated risk agreements.

Supports positive change in organizational clinical and financial outcomes by following established UM/PBM policy for cases under review by EPH pharmacy team(s).

Develops clinical competency related to coverage determinations made by the P&T and UM Committees. Reviews referrals, claims, and other requests (PA, Appeals, etc) for contracted payers and adheres to established criteria and policies.

Analyzes pharmacy and medical spend data (total cost of care, drug & medical trends). Reduces unnecessary/redundant medical benefit for medication therapy.

Actively supports department medication safety and quality improvement activities. Reports events through appropriate channels.

Participates in orientation/training of new team members. May work with interns, residents, and students to guide daily activities. May be preceptor-in-training.

Attends meetings at the system or practice level, and effectively communicates population health programs to providers and other stakeholders.

Maintains clinical and/or educational requirements for professional licensure and current position.

MINIMUM EDUCATION AND EXPERIENCE REQUIRED

License/Registration/Certification Required: Pharmacist license issued by the state in which the teammate practices.

Education Required: Bachelor’s Degree in Pharmacy

Experience Required: No Experience Required.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED

• Maintains advanced skills in areas of practice, demonstrating a commitment to continuing professional growth and advancement of the pharmacy profession.
• Demonstrated decision making, team building, customer service and conflict resolution.
• Strong computer skills.
• Excellent communication and organizational skills.
• Excellent presentation, facilitation, and training development skills.
• Demonstrated ability to work effectively with providers, staff, and patients.

PHYSICAL REQUIREMENTS AND WORKING CONDITIONS

• Must have functional speech, vision, and hearing.
• Operates all equipment necessary to perform the job.
• May be exposed to normal office/clinic environment.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.