Skip To Content
Laptop
J196907

UM Pharmacist

Highmark Inc.

  • Company Highmark
  • Buffalo, NY
  • Pharmacy
  • Full time
  • Day (United States of America)

Company :

Highmark Inc.

Job Description : 

Duties Note: The following is not intended to be an exhaustive list of all duties required of this position.
ADA
E1. Reviews prior authorization/non-formulary requests; ensures timely review of requests and determinations based on established criteria derived from NCQA and NYS Managed Care Legislation, medical literature and patient history supplied by the prescribing physician.
E2. Coordinates, researches and applies pharmaceutical knowledge to make determinations in pharmacy benefit appeals and grievances. Processes appeal and grievance records and paperwork.
E3. Collaborates with the Clinical Strategy Pharmacists to ensure clinical integrity of drug coverage policies.
N4. Other duties as assigned.

Education/Experience/Skills Requirements
Required Education:
Bachelors Degree:
Required Experience:
Three years’ experience in a managed care setting. PharmD or RPh with professional licensure.

Required Knowledge/Skills:
1. Excellent time management skills.
2. Expert knowledge of managed care, PPO and traditional pharmacy benefits offered across all divisions of the corporation.
3. Excellent organizational skills and attention to detail.
4. Excellent verbal and written communication skills.
5. Ability to work effectively with minor supervision.
6. Must be able to work in a fast-paced environment with daily work processing deadlines.
7. Prior experience in a fast-paced face-to-face customer service role working with daily deadlines and interruptions required.
8. High energy level and ability to project enthusiasm.
9. Polished, professional image and reputation.
10. Demonstrated customer service orientation.
11. Demonstrated personal accountability.
12. MS Word , MS Excel, Lotus Notes and Internet.
Required Licenses/Certifications:
Pharmacist
Problem Solving
Managerial/Supervisory Responsibilities
Does this Position have Supervisory Responsibility? No
Number of Emps Supervised:
Titles of Employees Supervised:
Financial/Budgetary Responsibilities:
Other Job Specifications:
External Contacts:
Working Conditions/Physical Demands:
Position requires:
* Must be able to work in an office environment
* PPD Skin Test may be required by healthcare facility for onsite facility work
Position involves:
* Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required tasks
* Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc)

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice


Thumbnail Join Talent Community@2X

Connect with a career that’s right for you.

Introduce yourself and we'll get in touch monthly to share career insights and company news.

Join Our Talent Community