Pharmacy Clinical Review Specialist

Job Summary

Managing pharmacy prior authorizations, the full-time Pharmacy Clinical Review Specialist will oversee clinical reviews, collaborate with clinicians, and ensure compliance with formulary guidelines while working remotely.

Key responsibilities:

• Oversee administrative processes related to pharmacy prior authorizations and manage first-line clinical reviews
• Act as a subject matter expert on formulary exceptions and perform peer reviews of prior authorization requests
• Interface with other departments to identify supporting medical documentation and maintain quality and production standards

Required qualifications:

• High school diploma with pharmacy claims, pharmacy tech, or related healthcare experience required
• Competency in pharmacy claims process operating systems
• Excellent knowledge of medical terminology and UPMC's Health Plan internal functions
• Proficiency in MS Office and PC skills
• Ability to prioritize tasks while maintaining production and quality standards