Applies clinical knowledge of drugs to utilization reviews.
Provides clear and concise communications in-line with Blue Shield’s brand.
Understands the function of drug formulary management and strategy to promote cost savings.
Provides quality service to members and providers.
Provides pharmaceutical expertise to all internal departments as needed.
Meets department goals for quantity and quality reviews.
Works effectively to ensure compliance with laws and regulations surrounding Utilization Management.
Exemplifies Code of Conduct and brand reputation.
Provides support and guidance to less experienced team members.
Resolves complex issues and problems as needed.
Acts and works in accordance with the organization's policies and applicable laws.
Skills :
Excellent oral and written communication skills
Excellent ability with MS office applications
Excellent math, analytical and problem-solving skills
Prior experience with claims processing vendors or prior authorization interfaces strongly recommended.
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Pharmacist • Rancho Cordova, CA, US
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