- Excellent mix of retail, clinical, prior authorization and managed care background
- Schedule: Mon to Friday --- 9 am to 530 pm NO WEEKENDS, NO HOLIDAYS
- Professional environment, lots of opportunities for growth
This position is responsible for creating and maintaining the utilization management clinical rules and criteria for Medicare standard and custom formularies for the enterprise and its clients. This position must ensure that the UM is compliant with CMS. This position is also responsible for ensuring the web and publications that support the formularies are also in alignment with the data bases that adjudicate the claims. This position will work with VAC, P&T and associated committees to ensure that the decisions are communicated to client facing groups, and to implement the decisions as determined by the committees. This position is responsible for ensuring that any new functionality required to support the business is designed and implemented as needed. This position may include other duties as assigned.