At UPMC, we are committed to keeping our communities safe and healthy as the COVID-19 pandemic unfolds.

Our recruiters will continue to fill positions throughout this time, but interviews and other processes may be modified to protect the safety of our candidates and employees. Thank you for your patience.

For more information about UPMC's response to COVID-19, please visit upmc.com/coronavirus.

Search Our Jobs

   Current UPMC employees must apply in HR Direct

Clinical Pharmacy Specialist (Temporary, part-time), Prior Authorization Team

Description

UPMC Health Plan is hiring two temporary Clinical Pharmacy Specialists to support the Prior Authorization team within the Pharmacy Services department. These are roles that may be fulfilled during daylight hours, evening hours or weekend hours depending on business needs.

This position 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. These services will be provided in compliance with state and federal regulations, NCQA, standards, the mission, policies and procedures of Health Plan and Pharmacy Department. Individual should demonstrate professionalism and commitment to meet UPMCHP 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 for approval/denial against standard criteria. 

Additional responsibilities include:

  • Administrative: Maintain a solid understanding of the requirements of the Pennsylvania Department of Health, DHS, CMS and the National Committee for Quality Assurance, specifically as they relate to the expectations of pharmacy operations. Ensure compliance with regulatory and accreditation requirements of clinical functions.
  • Communication: Foster and maintain collaborative relationships with internal and external stakeholders. 
  • Special Skills/Ability to Interact: Have ability to function independently, but support 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, employer, and patient confidentiality.

Qualifications

  • Bachelor of Science Degree in Pharmacy, and/or Doctor of Pharmacy Degree (Pharm.D.) from an accredited U.S. School of Pharmacy.
  • Experience in pharmacy benefit management, insurance, managed care preferred and be knowledgeable in therapeutic interventions and other cost containment programs.
  • Effective communication skills, both written and oral.Must have strong analytical ability and organizational skills.
  • Computer literacy for pharmacy programming, word processing, data management.Assessment of job related skills and competency will be reviewed annually via daily functioning, job-related documentation, department based competency programs, and continuing education activities.

Preferred Experience:

  • (1) PA Pharmacist Managed care residency or 1-3 years managed care experience, preferably in the development and execution of multiple utilization management techniques such as prior authorization, step therapy, quantity level limits, and other dose optimization techniques.
  • (2) Product Development Managed care residency or 1-3 years managed care experience in formulary development and management, especially in Medicare, Medicaid, Commercial and/or Exchange lines of business.
  • (3) Care Management - Managed care residency or 1-3 years managed care experience or at least 3 years of direct patient pharmacy practice experience, engaging in counseling and clinical services.


Licensure, Certifications, and Clearances:
Registration as a registered pharmacist (RPh), in the Commonwealth of Pennsylvania or eligibility for licensure by examination or reciprocity.Continuing Education requirements met each bi-annual cycle for re-licensure, as evident by obtaining a minimum of 30 hours of continuing education every 2 years in structured pharmaceutical education as necessary by the state board
 

  • Pharmacist


    UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct