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J203413

UM Pharmacist

Highmark Inc.

  • Company Highmark
  • Home, NY
  • Pharmacy
  • Full time

Company :

Highmark Inc.

Job Description : 

The individual in this position provides a high level of pharmaceutical based medical knowledge in order to support the effective administrative and utilization management of all corporate pharmacy and medical benefit programs.

Essential Responsibilities:

  • 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.
  • Coordinates, researches and applies pharmaceutical knowledge to make determinations in pharmacy benefit appeals and grievances. Processes appeal and grievance records and paperwork.
  • Collaborates with the Clinical Strategy Pharmacists to ensure clinical integrity of drug coverage policies.
  • Other duties as assigned.


Required Education:

  • Bachelors Degree


Required Experience:

  • Three years’ experience in a managed care setting.

Required Licenses/Certifications:

  • PharmD or RPh with professional licensure.
  • Pharmacist

Required Knowledge/Skills:

  • Excellent time management skills.
  • Expert knowledge of managed care, PPO and traditional pharmacy benefits offered across all divisions of the corporation.
  • Excellent organizational skills and attention to detail.
  • Excellent verbal and written communication skills.
  • Ability to work effectively with minor supervision. 
  • Must be able to work in a fast-paced environment with daily work processing deadlines.
  • Prior experience in a fast-paced face-to-face customer service role working with daily deadlines and interruptions required.
  • High energy level and ability to project enthusiasm.
  • Polished, professional image and reputation.
  • Demonstrated customer service orientation.
  • Demonstrated personal accountability.
  • MS Word, MS Excel, Lotus Notes and Internet.


Working Conditions/Physical Demands:

  • Must be able to work in an office environment
  • PPD Skin Test may be required by healthcare facility for onsite facility work
  • 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)

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

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


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