Department: 11215 System Pharmacy - Utilization Management Status: Full time Benefits Eligible: Yes Hours Per Week: 40 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 3 years of experience in managed care, specialty pharmacy, or oncology preferred 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. This is Transformation One shared purpose brought us together. Now, as one of the 10 largest not-for-profit, integrated health systems in the United States, our combined strength and stability drives us forward. Starting with You Caring for nearly 3 million people has inspired a transformation. One in which the patient’s experience guides our vision and empowers us to offer new possibilities in our communities. Reshaping Access What is access? It’s offering more sites of care than any other health system in the Midwest. But there’s a new frontier. Access is exploring the latest technologies to deliver care to patients exactly where they are and exactly when they need it Inspiring Professionals With our dynamically inclusive workforce and strong connections to the places where we live and work, we’ll touch more lives and contribute to stronger and more vibrant communities. Transforming Care We’re redefining the standard for care with world-class doctors and caregivers, innovative solutions, outstanding outcomes, and leading-edge research and clinical trials. Combined, Advocate and Aurora are recognized for clinical excellence in: Cardiovascular Care Neurosciences Gynecology Oncology Pediatrics Primary Care Neurology Geriatrics Trauma Care