Physician Pharmacy Reviewer
Physician Pharmacy Reviewer
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Salary Not Disclosed
1 Vacancy
Job Description
Job Summary
This position is critical to Priority Healths mission of improving the health and lives of the people we serve in collaboration with the health plans provider partners and major delivery systems. Expectations will include appropriate application of utilization management skills and strategies to assure the right care at the right time and the right price in the right location to promote high quality health outcomes. Work entails medical necessity reviews on weekends and holidays. Ideal candidates must have a strong sense of mission are interested in a high level of collaboration patientcentered care and evidencebased medicine. The Physician Reviewer can expect to work approximately 24 hours on 1 day holidays 4 6 hours per 2 day weekend and 6 8 hours per 3 day weekend.
Essential Functions
Understand Priority Healths mission strategic goals and value proposition for our communities and the people we serve.
Promote and advocate for patientcentered care evidencebased medicine and lower percapita costs; participate in the development of clinical utilization guidelines health management programs and clinical quality programs.
Provide clinical oversight to utilization management.
Qualifications
Required
Bachelors Degree
3 years of relevant experience in clinical setting
3 years of relevant experience Managed care experience
LICPhysician (MD) STATEMI State of Michigan or LICOsteopathic Physician (DO) STATEMI State of Michigan
Preferred
Proven experience and evidence of success in effective physician communication and education skills
Evaluation of evidencebased standards of care including the ability to critically analyze data
Clinical program development and assessment
Physician and clinical practice partnership development and application of utilization management skills and strategies.
3 years relevant managed care is required vs. preferred.
Knowledge of pharmaceuticals and general knowledge on related clinical guidelines
Knowledge and experience working with CMS rules and regulations related to coverage reviews and appeals Part D and Part B experience preferred
Geriatric experience (preferred but not limiter)
Ability to work within various systems and use technology efficiently (PA Logic UM portal)
About Corewell Health
As a team member at Corewell Health you will play an essential role in delivering personalized health care to our patients members and our communities. We are committed to cultivating and investing in YOU. Our topnotch teams are comprised of collaborators leaders and innovators that continue to build on one shared mission statement to improve health instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
#CorewellHealthCareers
How Corewell Health cares for you
Comprehensive benefits package to meet your financial health and work/life balance goals. Learn more here.
Ondemand pay program powered by Payactiv
Discounts directory with deals on the things that matter to you like restaurants phone plans spas and more!
Optional identity theft protection home and auto insurance pet insurance
Traditional and Roth retirement options with service contribution and match savings
Eligibility for benefits is determined by employment type and status
Primary Location
SITE Priority Health 1231 E Beltline Grand RapidsDepartment Name
PH Medical AffairsEmployment Type
Part timeShift
Day (United States of America)Weekly Scheduled Hours
20Hours of Work
8:00 a.m. to 5:00 p.m.Days Worked
Monday to FridayWeekend Frequency
N/ACURRENT COREWELL HEALTH TEAM MEMBERS Please apply through Find Jobs from your Workday team member account. This career site is for NonCorewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members patients visitors and community. We require a drugfree workplace and require team members to comply with the MMR Varicella Tdap and Influenza vaccine requirement if in an onsite or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process to perform the essential functions of a job or to enjoy equal benefits and privileges of employment due to a disability pregnancy or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race color national origin sex disability age religion genetic information marital status height weight gender pregnancy sexual orientation gender identity or expression veteran status or any other legally protected category.
An interconnected collaborative culture where all are encouraged to bring their whole selves to work is vital to the health of our organization. As a health system we advocate for equity as we care for our patients our communities and each other. From workshops that develop cultural intelligence to our inclusion resource groups for people to find community and empowerment at work we are dedicated to ongoing resources that advance our values of diversity equity and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
Employment Type
Part-Time
