Allegheny Health Network is hiring a Pharmacist - Utilization Management (UM) for a fully remote role. You will review requests for medication coverage determinations, including prior authorizations and appeals. Your core task involves evaluating clinical information against established medical policy criteria to make informed coverage decisions.
What You'll Do
- Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the Utilization Review system.
- Update system records appropriately to ensure claims are properly routed and paid.
- Conduct research beyond standard medical policy review to support decisions on medication coverage requests.
What We're Looking For
- Bachelor's degree in Pharmacy
- 1 - 3 years of relevant experience in Pharmacy
- Active registration as a Registered Pharmacist
Nice to Have
- Doctorate degree in Pharmacy
Benefits & Compensation
- Salary range: $67,500.00-$126,000.00
Work Mode
This is a fully remote position.
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