What are the responsibilities and job description for the Temporary Clinical Pharmacy Specialist- Prior Authorization Team position at UPMC?
UPMC Health Plan is hiring a temporary Clinical Pharmacy Specialist to support the Prior Authorization Team within the Pharmacy Services department. This is a work-from-home position, working flexible hours. Located anywhere in the United States but must be licensed in PA.
Registration as a registered pharmacist (RPh), in the Commonwealth of Pennsylvania or eligibility for licensure by examination or reciprocity is required.
The Clinical Pharmacy Specialist provides clinical pharmacy expertise to the development, implementation, and management of the pharmacy benefit. The clinical pharmacist assists in the management of pharmacy utilization and provides expertise in managing member care through the prior authorization and appeals process for medications. These services will be provided in compliance with state and federal regulations including NCQA and CMS standards while upholding the mission, policies and procedures of UPMC Health Plan and Pharmacy Department. Individual candidates should demonstrate professionalism and commitment to meet UPMC HP goals and objectives.
Responsibilities:
The Prior Authorization Pharmacist is primarily responsible for:
• Performing the clinical review of Prior Authorization, Step Therapy, Quantity Limit, and all other pharmacy utilization requests in accordance with quality, timeliness, and efficiency standards.
• Critically reviewing medication based prior authorization requests and utilization management requests for approval/denial against standard clinical criteria.
• Participate and contribute to other clinical and efficiency initiatives on an as needed basis.
Additional responsibilities include:
• Minimally, maintain a foundational understanding of the requirements of the Pennsylvania Department of Human Services, DHS, Centers for Medicare & Medicaid Services, CMS, and the National Committee for Quality Assurance, NCQA, specifically as they relate to the expectations of pharmacy operations. Ensure compliance with regulatory requirements of clinical operational functions.
• Foster and maintain collaborative relationships with internal and external customers. Communicate pharmacy information as appropriate to stakeholders.
• Have ability to function independently but support a virtual team concept. Behavior denotes reliability as demonstrated by prompt attendance and timeliness completing designated workload and follow-up. Conveys and maintains professional image while interacting with coworkers, providers, and clients. Honor client and patient confidentiality.
• Leverage thorough drug information skills to adequately research drugs and disease states pertaining to complex utilization management reviews or other ancillary responsibilities.
