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Utilization Management Pharmacist Trainer

1 month, 2 weeks ago
United States
Full-time
Mid Level
Customer Support
Customer and Technical Support
Apply Now
Capital Rx

Capital Rx

Capital Rx provides comprehensive health benefit management and transparent pharmacy benefit management solutions, integrating various healthcare services to support millions of plan members across diverse sectors.

Health Care Providers & Services
251-1K
Founded 2017
View All Jobs 9

Description

  • Facilitate onboarding and deliver training for pharmacists on prior authorization systems, processes, and procedures.
  • Develop and update training materials, resources, verbiage templates, and job aids.
  • Ensure training content is accurate, clinically relevant, compliant with regulations, and aligned with internal policies.
  • Maintain training records, attendance logs, and materials for auditing and reporting.
  • Assess pharmacist performance through evaluations, quizzes, and practical assessments and provide feedback.
  • Collaborate with pharmacy managers, supervisors, and stakeholders to identify training needs and performance gaps.
  • Make clinical prior authorization and appeals determinations within established turnaround times.
  • Document prior authorization cases, overrides, and call center cases thoroughly.
  • Perform peer-to-peer reviews with providers when requested.
  • Evaluate scientific literature and drug resources to support recommendations to providers.
  • Communicate issues and resolutions to members, pharmacies, providers, and internal stakeholders.
  • Provide backup support to the call center team as needed.

Requirements

  • Doctor of Pharmacy (Pharm.D.) or Bachelor of Pharmacy degree from an accredited pharmacy program.
  • Active, unrestrictive pharmacist license.
  • 3+ years of experience as a clinical pharmacist in a Pharmacy Benefit Management (PBM) setting.
  • Previous experience developing and delivering training programs.
  • Strong understanding of prior authorization operations and federal and state laws and regulations.
  • Excellent written communication and presentation skills for diverse audiences.
  • Excellent analytical skills and attention to detail.
  • Ability to collaborate with cross-functional teams and adapt to changing priorities.
  • Proficiency with e-learning platforms, multimedia tools, and Microsoft Office Suite.
  • Ability to work independently on a flexible schedule in a remote, high-volume, metric-driven call center environment.

Benefits

  • New York, Denver, and Charlotte salary range: $135,000-$145,000 USD.
  • Remote work environment.
  • Opportunity to work with a health technology company serving employers, unions, health plans, and government entities.
  • Flexible schedule with minimal supervision.

Interested in this position?

Apply directly on the company website

Apply Now

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