Job Summary:

We're a fully licensed health insurer. Our goal is to make healthcare simple, transparent, and human. We are changing how health insurance works by creating a healthcare experience that's intuitive and puts people, not cost or workflows, first. And we're using a consumer-focused and tech-driven approach to do so. This positions us uniquely in the space - and creates one of the biggest opportunities in healthcare.

In this role, you will play an essential role in building our pharmacy utilization management function. The Clinical Review team is one of most important clinical functions - we encourage evidence-based practice through utilization review to ensure our members get access to the right care - particularly those who need it most. You will be responsible for understanding and helping to grow our pharmacy utilization management program and driving high quality reviews.

Responsibilities:

• Completing review and rendering decisions on authorizations and appeals for specialty, non-specialty, and physician administered drugs
• Conducting peer-to-peers with prescribers to discuss the clinical rationale of adverse determinations
• Participating in clinical quality audits (inter-rater reliability testing)
• Providing internal team support for escalations and questions from pharmacy technicians and physicians
• Developing and reviewing clinical criteria

Experience Required:

• Must have 2+ years working in PBM or health insurance company doing prior auths or appeals
• We're looking for someone with 3+ years of experience in managed care performing clinical review/utilization management. Must-have qualifications and expertise include:
• Active, unrestricted pharmacy license
• Doctor of Pharmacy Degree
• Willingness to obtain licensure/training with new states, as needed
• Acute attention to detail and excellent written and verbal communication skills
• Strong clinical skills and experience applying clinical criteria in clinical review setting
• Ability to obtain and maintain secure, high-speed and consistent internet connectivity

Benefits:

Minimum Essential Coverage (MEC) plan

• Two different fixed indemnity plan add-ons
• Major Medical Plans, including 1 HSA Plan
• Dental
• Vision
• Short-term disability
• Life and AD&D

Hours: 4 - 10 hour shifts (8 or 10 hour shifts between 7am - 5:30 pm CST)

**1 Weekend day each week required after training and nest period are complete**

Training Hours: M-F 8am - 5pm CST (4 weeks) / 2 week nesting period

Location: (100% Remote)

Educations/Certification Requirements::

Pharmacist License Active/ Doctor of Pharmacy Degree

Pay: $60/hr