Job details Salary $50 - $65 an hour Job Type Full-time Number of hires for this role 1 Full Job Description
We’re a fully licensed health insurer. Our goal is to make healthcare simple, transparent, and human. We are changing how health insurance works by creating a healthcare experience that’s intuitive and puts people, not cost or workflows, first. And we’re using a consumer-focused and tech-driven approach to do so. This positions us uniquely in the space - and creates one of the biggest opportunities in healthcare.
In this role, you will play an essential role in building our pharmacy utilization management function. The
Clinical Review team is one of Oscar’s most important clinical functions - we encourage evidence-based practice through utilization review to ensure our members get access to the right care - particularly those who need it most. You will be responsible for understanding and helping to grow our pharmacy utilization management program and driving high quality reviews.
- Completing review and rendering decisions on authorizations and appeals for specialty, non- specialty, and physician administered drugs
- Conducting peer-to-peers with prescribers to discuss the clinical rationale of adverse determinations
- Participating in clinical quality audits (inter-rater reliability testing)
Providing internal team support for escalations and questions from pharmacy technicians and physicians
- Developing and reviewing clinical criteria
- We’re looking for someone with 3+ years of experience in managed care performing clinical review/utilization management. Must-have qualifications and expertise include:
- Active, unrestricted pharmacy license
- Doctor of Pharmacy Degree
- Willingness to obtain licensure/training with new states, as needed
- Acute attention to detail and excellent written and verbal communication skills
- Strong clinical skills and experience applying clinical criteria in clinical review setting
- Ability to obtain and maintain secure, high-speed and consistent internet connectivity
- 5+ years of experience performing clinical review and experience writing clinical criteria
- Board Certification (i.e. BCPS, BCOP)
- Residency training
- Experience practicing pharmacy in a clinical setting (i.e. retail, hospital, specialty, etc.)
Medix is dedicated to positively impacting lives every day. Since 2001, we have made it our mission to be the leading provider of workforce solutions for clients and candidates across the Healthcare, Scientific, and
Information Technology industries .
Our dedicated recruiters are here to help you find and secure just the right opportunity. We take the time to learn about you, your skills, your interests, and your career goals, and then match you with the jobs and companies that best suit your needs. Whether you are looking for a contract, contract-to-hire, or direct hire positions, we can help you to find the meaningful and gratifying work that you've been looking for. Let Medix be your partner as you move your career forward. Contact us today!
Once you have been a contract employee of Medix for 30 days, you become eligible for our Benefits
Program. Should you elect to enroll, there are three levels of medical coverage to choose from, supplemental dental plans and term plans as well as the option to enroll your spouse and/or children. You can select the best combination that best suits your needs.
As a contract employee with Medix, you can choose to enroll in our Benefits Program during your eligibility period and enjoy:
- Minimum Essential Coverage (MEC) plan
- Two different fixed indemnity plan add-ons
- Major Medical Plans, including 1 HSA Plan
- Short-term disability
- Life and AD&D
Job Type: Full-time
Salary: $50.00 - $65.00 per hour
- One location
Work Location: One location
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