Job Description

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

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Job Summary :

The Clinical Pharmacy Coordinator executes clinical programs related to utilization management, care management, and quality improvement. To do this, this position will have knowledge of pharmaceutical services provided under both the pharmacy and medical benefits. The Clinical Pharmacist Coordinator will be responsible for pharmaceutical service request reviews and render determinations of medical necessity and appropriateness of request. 

The Clinical Pharmacy Coordinator holds an active, unrestricted license or certification to practice pharmacology medicine in a state or territory of the United State s.  They are qualified to render appeal determinations in addition to initial determinations and non-certifications. The Clinical Pharmacy Coordinator Reviewers have access to consult with initial clinical reviewers, other medical advisors, licensed doctors, or peer reviewers through several modes of contact. The position will regularly interface with the pharmacy benefits manager, pharmacies, provider offices, members, brokers, and employer groups. This position will also assist with compliance and business development activities. The Clinical Pharmacy Coordinator assists in maintaining and updating clinical policies relevant to drug utilization management.

The Clinical Pharmacy Coordinator will also support the Prominence DSNP Model of Care by reviewing medications for members on that plan and communicating with prescribers to assure medications are not duplicative, interactive, and appropriately dosed for the elderly as part of an Interdisciplinary Care Team.

About Universal Health Services:

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.

Required :

• Pharm.D. or BS Pharmacy
• Active/Current Pharmacist licensure in good standing
• Experience applying clinical criteria in prior authorization review setting

Preferred :

• 2+ years of previous health plan experience, including Medicare Advantage
• Written and verbal Spanish language proficiency

S pecialized subject matter expertise in one or more of the following topics required :

• Home infusion pharmacy operations
• Commercial HMO/PPO/POS
• Medicare Part D
• Mail Service/Specialty pharmacy
• Pharmaceutical benefit design
• Oncology treatment guidelines
• Other facets of pharmaceutical, managed care, and PBM industries

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Avoid and Report Recruitment Scams

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS

and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.

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