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The Cigna Group · 5 hours ago

Staff Pharmacist

United States

Contract

Remote

Senior Level, Lead/Staff

$50/hr - $60/hr

5+ years exp

The Cigna Group is seeking a Utilization Management Pharmacist responsible for reviewing plans' policies to determine medication coverage. The role involves providing clinical support for utilization management activities and finalizing denials of clinical prior authorization requests.

CommercialHealth CareHospitalInsuranceMedical

Responsibilities

Responsible for finalizing all denials of clinical prior authorization requests

Supports the Coverage Review Department (CRD) as a clinical resource for drug therapy questions

Applies critical thinking to achieve proper clinical decisions when performing clinical reviews

Utilizes multiple systems and other clinical resources to achieve proper decisions in Utilization Management reviews

Works and maneuvers within a queue system that prioritizes clinical reviews

Makes clinical decisions quickly and at times decides and acts with limited information

Works and collaborates with a multi-disciplinary clinical team to provide a customer centric experience

Qualification

Clinical Pharmacy ExperienceLicensed Registered PharmacistUtilization Management ExperienceSpecialty Pharmacy ExperienceMicrosoft Office ProficiencyLeadership ExperienceCritical ThinkingCollaboration Skills