Clinical Pharmacist (Utilization Management)

Job Purpose

Ventegra is a fast-paced, innovative virtual company. The “Clinical Pharmacist – Utilization Management” is a key position intended to facilitate the implementation and ongoing maintenance of the Ventegra Medical Benefit Management (MBM) business model for clients. This position will provide support for many operational functions and processes, including, but not limited to, clinical guidelines, prior authorizations, appeals and grievances, and utilization management. The Ventegra Clinical Pharmacist – Utilization Management will play a key role in ensuring the ongoing quality and delivery of Ventegra’s MBM services.

Duties and Responsibilities

• Perform clinical evaluation for coverage determination requests for prior authorization (PA) or other utilization management (UM) programs, including quantity limits, step therapy, formulary exclusion, and tier exception; this includes consideration of the denial language and appropriateness of the decision as it pertains to the clinical content of the case and the intent of the medication utilization criteria.
• Provide clinical and administrative support to other teams for prior authorization and client management.
• Update existing and create new medication utilization criteria using current guidelines, evidence-based pharmacotherapy, and clinical knowledge.
• Collaborate with team members to promote consistency of decisions across the pharmacist team.
• Respond to healthcare professionals during peer-to-peer consultations with the relevant clinical rationale to facilitate the use of formulary medications.
• Employ clinical knowledge and drug information skills for various departmental projects.
• Provide and discuss clinical tools, solutions, and support process enhancements for the clinical team.
• Conduct other duties related to Ventegra’s MBM program as needed.
• Demonstrates flexibility and timely execution of assigned tasks.
• Travel as required.
• Additional duties as assigned.

Required Skills and Abilities

• Excellent verbal and written communication skills.
• Must possess strong relationship and strategic partnering skills.
• Proficiency in Microsoft Office products required.
• Ability to work independently yet cohesively within a team to achieve results.
• Strong problem-solving skills.

Education and Experience

• Doctor of Pharmacy (PharmD) required
• Active and unrestricted pharmacist license in the United States
• Residency and additional certification or advanced education are preferred.
• Two years of experience in prior authorization, utilization management, or managed care is preferred OR a varied work experience history involving direct patient care with strong clinical judgment from retail or hospital pharmacy is preferred

Work environment requirements

A home office setting, free from noise and distraction, allowing you to interact professionally both externally and internally.

Pay: $60.00 - $65.00 per hour

Expected hours: 40.0 per week

Education:

• Doctorate (Required)

Experience:

• prior authorization, utilization management, or managed care : 2 years (Preferred)
• direct patient care from retail or hospital pharmacy: 2 years (Preferred)

License/Certification:

• Licensed Pharmacist (Required)

Location:

• United States (Preferred)

Work Location: Remote