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Pharmacist - Utilization Management (UM)
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- Pharmacist - Utilization Management (UM) at Highmark Health in Boise, Idaho, United States Job Description Company : Highmark Inc. Job Description : JOB SUMMARY This job reviews requests for medication coverage determination for prior authorization review and appeals.
- Through the Utilization Review system, the incumbent evaluates clinical information provided by the physician against medical policy criteria.
- ESSENTIAL RESPONSIBILITIES + Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the Utilization Review system.
- Update the system records appropriately to ensure claims are properly routed and paid.
- Conduct research beyond medical policy review to make decisions on medication coverage requests.
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