Remote Utilization Management Jobs in Utah (NOW HIRING)

Clinical Pharmacist Consultant or Sr. DOE

Work from home within Oregon, Washington, Idaho or Utah

Candidates must be available to work Pacific Standard Time (PST) hours irrespective of their physical location.

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day, Cambia's dedicated team of Pharmacy Consultants are living our mission to make health care easier and lives better. As a member of the Pharmacy Services team, our Clinical Pharmacist Consultants provide professional and clinical pharmacy expertise in making or guiding clinical decisions based on best practices by creating and applying evidence-based medicine evaluations to determine the best quality medication choices that represent the best value in efficacy, safety and affordability. This may include providing coverage recommendations for medications subject to prior authorization based on applicable medication coverage policies and member benefit contracts or serving as a resource for other staff. This role may also assist in planning, developing, and implementing clinical strategies with respect to formulary management, drug utilization management, and peer-to-peer conversations. Additional responsibilities may include development of position papers, medication coverage policies, formulary monographs and class reviews, cross-functional projects, and/or initiatives related to the provision of pharmacy benefits that impact safety, quality and affordability - all in service of creating a person-focused health care experience.

Do you want to impact medication safety and affordability on a larger scale? Ready to collaborate on cross-functional projects that shape pharmacy benefits? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

• Bachelor's degree in Pharmacy or Doctor of Pharmacy (PharmD) or related field

• Minimum 3-5 years of experience in clinical acute care/hospital setting or equivalent combination of education and experience

• Pharmacy license. Successful completion of a pharmacy residency or advanced degree in health-related field preferred. Must be an active and unrestricted licensed pharmacist in state of practice

Skills and Attributes:

• Strong clinical pharmacy background with ability to demonstrate clinical therapy skills and knowledge in a clinical care setting.

• Excellent verbal and written communication skills; strong business analytical skills and abilities; strong project management and coordination ability.

• Ability to work independently, to prioritize work, meet deadlines and achieve operational goals

• Demonstrated success in managing professional relationships in a managed care system, medical group, hospital, or related organizations.

• Ability to collaborate as part of cross functional teams, to improve clinical programs, enhance processes and share clinical information.

• Knowledge of pharmaceutical products, including orals, injectables, infusion products, and chemotherapy; state and federal laws and rules regarding the practice of pharmacy and regulation of health care industry practices, such as DOLI, PPACA and HIPAA.

• Strong knowledge of health care economics and financing; health care/pharmaceutical industry dynamics; and pharmacy/provider service reimbursement of medications.

• Knowledge of Health Plan and benefit design structures and application; Medicare/CMS regulations and applicability in administering the Medicare Product; health care coding and payment systems (such as ICD-9, CPT, HCPCS, NDC).

• Strong knowledge of compliance related activities, legislative and regulatory activities, health insurance operations, and legal issues.

• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

What You Will Do at Cambia:

• Provide clinical decision-making based on best practices in applying evidence-based medicine process in determining medications that have best value for efficacy and safety.

• Provide coverage recommendations for medications subject to prior authorization, appeals, retrospective claim reviews, and audits based on applicable medication coverage policies, member benefit contracts, and provider contracts.

• Complete peer-to-peer conversations with external healthcare professionals.

• Develop position papers, medication coverage policies, formulary monographs and class reviews, and formulary coverage recommendations based on critical appraisal of the scientific literature and input from practicing physicians to ensure optimal clinical outcomes at most cost-effective level.

• Present and/or communicate clinical positions on medication analysis in clear, concise manner.

#LI-Remote

Pay ranges vary based on the candidate's work location. The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history.

Clinical Pharmacist Consultant

• Oregon, Washington, Utah, and Idaho:The expected hiring range is$121,600 - $164,500, the full salary range is$114,000 - $186,000 and the bonus target is 15%.

• North Dakota:The expected hiring range is$128,145.07 - $173,372.75 and the full salary range is$113,780.47 - $187,737.35.

Clinical Pharmacist Consultant Sr.

• Oregon, Washington, Utah, and Idaho:The expected hiring range is$136,000 - $184,000, the full salary range is$128,000 - $208,000 and the bonus target is20%.

• North Dakota:The expected hiring range is$145,150.31 - $197,732.77 and the full salary range is$129,767.26 - $214,115.82.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can:

• Work alongside diverse teams building cutting-edge solutions to transform health care.
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
• Grow your career with a company committed to helping you succeed.
• Give back to your community by participating in Cambia-supported outreach programs.
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

Learn more about our benefits.

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.