Pharmacist - Utilization Management - Southwestern Health Resources (SWHR)

Here’s What You Need

Education

• Require Doctor of Pharmacy or Pharm D. from an ACPE accredited college.

Experience

• Require 4 years of experience in a Managed Care Pharmacy or Health Plan environment as a Clinical Pharmacist or Prior Authorization Pharmacist, OR, require Pharmacy Residency with experience which would provide an equivalent background.
• Prefer knowledge of insurance and regulatory body guidelines, processes, and systems as well as working knowledge of pharmacy practices and procedures.
• Prefer knowledge of and experience in CMS guidelines, processes and systems programs such as Medicare.

• Prefer oncology experience.

Licenses & Certifications

• Require Pharmacist license from Texas State Board of Pharmacy upon hire.
• Prefer Board-Certified Clinical Pharmacy Specialist or Board-Certified Oncology Pharmacist Specialist.

Skills & Abilities

• Must be highly organized and detail oriented.
• Strong verbal and written communication skills required.
• Knowledge of Medicare coverage criteria and specific regulatory or managed care requirements/regulations medical drug reviews.
• Strong clinical pharmacy skills including knowledge of clinical guidelines and compendia.

What You Will Do

Position Responsibilities

The Utilization Management (UM) Pharmacist will provide pharmacy expertise to a variety of clinical and complex situations for the Utilization Management Department in the Managed Care environment. This position is accountable for Part B clinical medication reviews and possibly, when necessary, assists with Part D evaluations, completion of peer-to-peer requests as needed, and assist in clinical programs which may focus on total cost of care initiatives. This position will provide assistance with efficiency and quality assurance of medical necessity reviews in alignment with Federal, State, Plan, and Accreditation standards. There will be cross departmental functions with a variety of personnel in operations, quality and compliance, and medical director staff to provide pharmacy services in the managed care environment.

Position Functions

• Provide comprehensive, due-diligent medical necessity determinations for Part B pharmacy drug reviews including, but not limited to, oncology, hematology, infectious disease, and specialty medications.
• Provide operational support of Part B drug reviews, prior authorization list maintenance and management, and process flows.
• Assist in the development and maintenance of policy and procedure documentation for clinical programs.
• Serving as drug information and clinical pharmacy expert. Supporting internal departments including but not limited to provider engagement at division meetings and in consult with physicians pertaining to drug data and drug information to assist with internal and external decision making of cost-control opportunities.
• Is responsible for compliance with the policies and procedures, the standards of accrediting bodies, and the regulations of federal, state, and local governing agencies.
• Education and oversight of pharmacy technician staff.
• Provide support for internal educational programs and externally through written newsletter articles and provider engagement presentations.
• Complete all compliance, regulatory and process training within the specified timeline.

Why Southwestern Health Resources 

As a Southwestern Health Resources employee, you’ll enjoy, comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.

• Additional perks of being an SWHR employee:
• Gain a sense of accomplishment by contributing to a teamwork environment.
• Positively impact patients’ quality of life.
• Receive excellent mentorship, comprehensive training and dedicated clinical and administrative leadership resources.
• Enjoy opportunities for growth.

Explore Southwestern Health Resources Careers for more information and to search all career opportunities.

Our Recruitment team invites you to contact us with any questions at recruitment@texashealth.org

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