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Pharmacy Utilization Management Specialist

InnovaCare

This is a Contract position in Las Vegas, NV posted December 4, 2022.

Orlando Family Physicians, LLCJob Title: Pharmacy UM SpecialistReport to: Pharmacy ManagerFLSA Status: Non-ExemptWork Place: HybridService Area: Seminole, Orange, Osceola, and Volusia CountiesResponsibilities:Utilization Management:
•The Pharmacy UM Specialist will focus on high cost orspecialty medicationmanagement by disease class and medication cost comparison.
•Assist in managing different health plan’s multi-tiered medication formulary;proactively review costly medications and provide alternatives by referencing andaligning OFP’s Preferred Drug List (PDL) and Health plan’s formulary
•Assess prior authorization for high-cost specialty medications and promote steptherapy approach.
•Collaborate with a Pharmacy network to narrow down options for cost-containment.
•Notify providers of drug safety alerts, recalls, and clinical updates to assist them inselecting alternative therapy.
•Assist providers in choosing medications that will meet patients’ needs and be eligiblefor coverage.Medication Adherence:
•The Pharmacy UM Specialist will apply knowledge and skills to conduct an in-depthdiscussion with patients about medications to identify and resolve patient adherencebarriers.

This role may involve analysis, critical thinking, research, and problem-solvingskills to obtain resolution.
•Applied judgment is required to develop, modify, and adapt procedures to meetdemands effectively in atypical situations.
•Assist members in a 90-Day refill mail orders enrollment or online services to promotelow-costly options for members and ensure quality outcomes.

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