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Full Time Utilization Management Pharmacist Jobs in Indiana

Trinityhealth

Pharmacist - Specialty Pharmacy

Fort Wayne, IN · On-site

$57.50 - $69/hr

Employment Type: Full time Shift: Description: POSITION PURPOSE- located in Fort Wayne, Indiana The ... Performs drug utilization reviews. Identifies and documents utilization management and ...

AlixaRx, LLC

Pharmacist

Indianapolis, IN · On-site

$55.75 - $67/hr

... on utilization management concepts and activities, pharmacy staff training evaluation and ... Pharmacist preferred * License to practice pharmacy is required in the state of the position is ...

AlixaRx, LLC

Pharmacist

Indianapolis, IN · On-site

$55.75 - $67/hr

... on utilization management concepts and activities, pharmacy staff training evaluation and ... Pharmacist preferred * License to practice pharmacy is required in the state of the position is ...

Well Care Community Health, Inc

Pharmacist

Austin, IN · On-site

$140K - $160K/yr

... drug utilization reviews and check for drug interactions when filling every prescription ... proper inventory management, and other areas as assigned by Regional Pharmacy Manager ...

Ernest Health

Pharmacist

Mishawaka, IN · On-site

$53.50 - $64.25/hr

Overview Pharmacist - Full Time - Mishawaka, Indiana Rehabilitation Hospital of Northern Indiana in ... Effective organizational and time management skills. * Effective written and verbal communication ...

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Full Time Utilization Management Pharmacist information

What are some common challenges faced by full time utilization management pharmacists, and how can they be addressed?

Full Time Utilization Management Pharmacists often encounter challenges such as balancing clinical guidelines with insurance policy requirements, managing high volumes of prior authorization requests, and communicating effectively with healthcare providers. Staying updated on formulary changes and payer criteria is essential. Building strong relationships with providers and utilizing technology to streamline workflows can help mitigate these challenges and ensure patients receive appropriate and timely care.

What are the key skills and qualifications needed to thrive as a full time utilization management pharmacist?

To thrive as a Full Time Utilization Management Pharmacist, you need a Doctor of Pharmacy (PharmD) degree, state licensure, and strong knowledge of drug therapies, formulary management, and clinical guidelines. Expertise with pharmacy benefit management (PBM) systems, electronic health records (EHRs), and prior authorization platforms is typically required. Exceptional communication, analytical thinking, and attention to detail are crucial for collaborating with healthcare providers and ensuring optimal patient outcomes. These competencies enable pharmacists to effectively evaluate medication use, promote cost-effective care, and uphold regulatory standards in managed care environments.

What is the difference between Full Time Utilization Management Pharmacist vs Utilization Review Pharmacist?

AspectFull Time Utilization Management PharmacistUtilization Review Pharmacist
CredentialsPharmacy Degree, Licensure, Certification in Utilization ManagementPharmacy Degree, Licensure, Certification in Utilization Review
Work EnvironmentHealthcare organizations, insurance companies, managed care settingsInsurance companies, healthcare providers, managed care organizations
Job FocusManaging medication utilization, reviewing prior authorizations, ensuring appropriate drug useAssessing medical necessity, reviewing patient cases, approving or denying coverage
Industry UsageCommon in managed care and insurance sectorsCommon in insurance and healthcare provider settings

The Full Time Utilization Management Pharmacist primarily focuses on medication management and prior authorization processes within healthcare organizations. In contrast, the Utilization Review Pharmacist concentrates on evaluating medical necessity and approving coverage for treatments. Both roles require similar credentials but differ in their specific responsibilities and work environments.

What is a full time utilization management pharmacist?

Full Time Utilization Management Pharmacists are licensed pharmacists who work primarily to evaluate and manage the appropriate use of medications within healthcare systems, often for insurance companies or pharmacy benefit managers. Their role includes reviewing medication requests, ensuring prescriptions meet evidence-based guidelines, and collaborating with healthcare providers to optimize patient outcomes while controlling costs. They work standard full-time hours and focus on clinical decision-making, policy development, and utilization reviews rather than dispensing medications.
What are the most commonly searched types of Utilization Management Pharmacist jobs in Indiana? The most popular types of Utilization Management Pharmacist jobs in Indiana are:
What cities in Indiana are hiring for Full Time Utilization Management Pharmacist jobs? Cities in Indiana with the most Full Time Utilization Management Pharmacist job openings:
Full Time Utilization Management Pharmacist jobs near you

Utilization Management Nurse

SIHO Insurance Services

Columbus, IN

Full-time

Re-posted 13 days ago

Job description

Job Title:  Utilization Management Nurse
Reports To: Manager of Utilization Management
Employment Type:  Full-Time, Exempt 

Brief Description of Duties:     
This position is reserved for a licensed Registered Nurse who will perform the Utilization Management (UM) services for SIHO (and affiliated business lines’) members. This individual’s primary role is to ensure that health care services are administered with quality, cost effectiveness, and compliance to plan guidelines are maintained. By performing review of services prospectively, retrospectively, and throughout the episode of care, the UM nurse will make coverage determinations influencing how services are allocated to SIHO’s various member populations.  A candidate’s ability to perform quality reviews within strict efficiency standards is required for this position.  Key responsibilities are as follows: 
- Pre-service, concurrent, and post-service review of necessity of health care services utilizing enrollee medical records and established guidelines set by SIHO and/or state and federal (CMS) guidelines
- Interaction with the member, health care provider, and/or other care team members to complete reviews in most time-efficient manner
- Interaction with the SIHO Medical Director as needed to ensure proper medical necessity decisions are made in a timely manner
- Appropriate documentation of the entire review process utilizing the established documentation system and desk procedures to guarantee accurate reporting metrics and data integrity
- Complete case review and elevation to determinations that are rendered within the contractual and regulatory turnaround times established by SIHO and CMS
- Assist to resolve problems and provide guidance to members of the team and cohorts
-Interpret and abide by organizational policies and procedures; review work regularly to ensure that policies and guidelines are appropriately applied
-Act as a clinical resource to the department and other organization members for services pertaining to medical management, utilization review, and medical necessity
- Act and perform within the scope of professional nursing practice; is responsible in supporting and participating in department strategies and efforts focused on quality improvement
- Responsible for the early identification and assessment of members for inclusion in disease management or care management programs
- Assist in the identification and reporting of Potential Quality of Care concerns and Fraud, Waste and Abuse incidents
- Work as an interdisciplinary team member within Medical Management for all lines of business and commercial group plans 

Minimum Skills Requirement: 
- Registered Nurse with current, unrestricted license in primary state of employment (position may require additional licensing in other states as necessary)Previous UM or Health Plan experience highly preferred
- Desire to work in a fast-paced environment with focus on efficiency while maintaining quality
- Self-directed organization and prioritization skills, and independent time management skills required
- Sound clinical background with experience in the clinical field
- Excellent verbal and written communication skills
- Microsoft Office Experience: Outlook, Word, Excel

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.