Job Description

Job Title: Pharmacy Clinical Review Specialist I - Health Plan (Temporary Part-Time)
Job ID: 72920018
Status: Part-Time
Regular/Temporary: Temporary
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: PHARMACY SRVCS
Location: 600 Grant St, Pittsburgh PA 15219

Description

UPMC Health Plan is hiring a Temporary Pharmacy Clinical Review Specialist to assist with operations in the Pharmacy Services department.  This is a temporary assignment (six months) and a part-time opportunity - great for students or someone looking to get into the pharmacy world. This person will oversee administrative and system processes that relate to pharmacy prior authorizations. Manage the first line clinical review of prior authorization requests on behalf of physicians and UPMC Health Plan members. Collaborate with clinicians regarding supporting medical documentation in accordance with formulary guidelines. Manage the quality review of requested prior authorizations.



 

Responsibilities:

  • Provide excellent internal and external customer service maintaining a second requests for information and customer complaint goal of zero.
  • Act as a conduit of information between the Pharmacy Service Representatives and the clinical staff
  • Subject matter expert on formulary exceptions and prior authorization requirements/time frames according to line of business.
  • Perform peer reviews of prior authorization requests.
  • Maintain or exceed designated quality and production standards.
  • Develop and maintain the pre-logic and clinical criteria in support of the prior authorization determination process.
  • Interface with other departments and identify medical documentation in support of prior authorization requests.
  • Complete standard/expedited pharmacy coverage determinations according to departmental/government guidelines.

Qualifications

  • High School Diploma Strongly Preferred
  • Post-secondary education is preferred
  • Six months of previous pharmacy experience/knowledge is highly preferred
  • Must have proficiency with Microsoft Office Suite: Excel, Word, Outlook and Powerpoint
  • Must possess typing skills and working knowledge of word processing, electronic mail/calendar and spreadsheets
  • Must possess the ability to learn and effectively use various software programs
  • General knowledge and experience with office equipment such as copiers, multi-line phone systems, fax machines and paging systems

    Licensure, Certifications, and Clearances:

    UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $0 / hour

Union Position: No

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