Role Description We are seeking an experienced Medical Reviewer with expertise in Signal Detection to play a critical role in pharmacovigilance operations, ensuring the ongoing safety and regulatory compliance of pharmaceutical products. The ideal candidate will be responsible for: - Medical evaluation of Individual Case Safety Reports (ICSRs) - Identification and assessment of safety signals - Proactive risk evaluation using advanced safety databases and statistical tools - Contributing to key safety deliverables such as PSURs, PBRERs, DSURs, and Risk Management Plans - Supporting safety governance, regulatory submissions, and audits This position is essential in safeguarding patient safety and maintaining the integrity of product safety profiles in a dynamic, global environment. Qualifications - MBBS (Required) - Postgraduate qualification in Pharmacology, Clinical Research, or Drug Safety (Preferred) - 5+ years of hands-on experience as a Medical Reviewer with demonstrated expertise in signal detection and evaluation - Strong knowledge of pharmacovigilance processes and signal detection methodologies - Proficiency with safety databases (Argus, ArisG, Veeva Safety, etc.) - Experience with disproportionality analysis and signal detection tools (e.g., Empirica Signal) - In-depth understanding of global PV regulations (ICH E2E, E2D, GVP Modules) - Proven clinical evaluation and medical writing skills - Excellent analytical, communication, and decision-making abilities - Strong presentation and interpersonal skills - Effective intercultural communication and collaboration abilities - Commitment to timely task completion, accurate documentation, and adherence to deadlines - Demonstrated problem-solving and critical thinking skills Requirements - Location: Mumbai, Maharashtra, India - Mode of Work: Remote - Department: Pharmacovigilance / Drug Safety - Qualification: MBBS - Must Have Hands-On Experience as a Medical Reviewer with Signal Detection Experience - Experience Required: 5+ years as a Medical Reviewer - Notice Period: Any - Employment Type: Full Time - Salary Range: Based on your Previous CTC

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Clinical Pharmacist (Prior Authorization) is responsible for managing the selection and utilization of pharmaceuticals and supports core clinical programs such as DUR, DIS, and formulary management. - Researches and synthesizes detailed clinical data related to pharmaceuticals. - Prepares and presents therapeutic class reviews and drug monograph information to the Pharmacy and Therapeutics Committee. - May review and approve or deny coverage for pharmaceuticals based on medical necessity criteria. - Coordinates with internal stakeholders or health plan medical directors as needed. - Serves as a clinical resource to other pharmacists on areas such as prospective, inpatient, and retrospective DURs. - Provides dosage conversion and clinical support for therapeutic interventions. - Prepares information for network physicians. Qualifications - Requires BA/BS in Pharmacy. - Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience. - Requires a registered pharmacist. - Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh). - For associates working within Puerto Rico, a current PR health certificate and a current PR Law 300 certificate are required. Requirements - Possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh) in Indiana. - PharmD strongly preferred. - Must be located in a state or territory of the United States when conducting utilization review or appeals consideration. - For URAC accredited areas, expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. Benefits - Market-competitive total rewards including merit increases. - Paid holidays and Paid Time Off. - Incentive bonus programs (unless covered by a collective bargaining agreement). - Medical, dental, and vision benefits. - Short and long-term disability benefits. - 401(k) + match. - Stock purchase plan. - Life insurance. - Wellness programs and financial education resources.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Utilization Review Nurse will provide professional assessments and review for the medical necessity of treatment requests and plans. The standard work schedule is Monday through Friday, 8:00 AM–5:00 PM Pacific Standard Time, with rotating weekend coverage as required. - Provide professional assessment and review for the medical necessity of treatment requests and plans. - Provide first level review for: - All outpatient and ancillary pre-certification requests for medical appropriateness - Inpatient hospital stay including mental health, substance abuse, skilled nursing, and rehabilitation for medical necessity - Post claim or post service reviews - Cross train and provide cross coverage as needed. - Work to the top of the RN license and ensure proper referral to medical director for denial authorizations through independent review organizations (IRO). - Work with hospital staff to prepare patients for discharge and ensure a smooth transition to the next level of care. - Refer requests that fall outside of established guidelines to advance review or senior care consultants. - Process appeals for non-certification of services and complete non-certification letters when appropriate. - Review plan document for benefit determinations and attempt to redirect providers and patients to PPO providers. - Identify and refer potential cases to case management, wellness, chronic disease, and Nurturing Together programs. - Complete documentation for all reviews in appropriate documentation software. - Utilize guidelines in appropriate hierarchy, including MCG guidelines, internal medical policies, group specific policies, and NCCN. - Ability to meet productivity, quality, and turnaround times daily. - Ability to pass external audits to include URAC and NCQA. - Maintain HIPAA compliance per company’s policy and procedures. - Maintain confidentiality and minimum requirement rules. - Complete all required yearly training per company’s expected time limit. - Complete and pass all annual testing including IRRA at 90% or higher. Qualifications - Current RN license in the United States or U.S. territory. - Associate’s degree or diploma (Nursing program) required. - 1+ year clinical experience required. Requirements - Ability to perform the essential job functions safely and successfully with or without reasonable accommodation, including meeting qualitative and/or quantitative productivity standards. - Ability to maintain regular, punctual attendance. - Ability to sit for 6-8 hours. - Constant use of computer keyboard and mouse; repetitive use of both hands. - Occasional to frequent twisting of neck; occasional bending of neck and at waist. - Must be able to remain in a stationary position 50% of the time. - Occasionally move about inside the office to access office machinery, filing cabinets, and meeting facilities. - Constantly operate a computer and other office productivity machinery, such as copy machine, computer printer, calculator, etc. - Frequently position self to maintain files in file cabinets. - Frequently move boxes or equipment weighing up to 25 pounds. - Must communicate information and ideas so others understand. - Must be able to observe details at close range. Benefits - Competitive base salary and benefits effective day one. - Comprehensive medical and dental through our own health solutions. - Paid Time Off—rest and recharge time is non-negotiable. - Mental health support, retirement planning, and financial protection. - Professional development with clear career progression and learning budgets. - Mission-driven culture where diverse perspectives drive real impact on people's health. Visit personifyhealthbenefits.com to explore our complete benefits package, wellness programs, and other employee perks. This position offers a base salary range of $30-$38 per hour, depending on location, skills, and experience. You're eligible for our full benefits package starting day one. Company Description Personify Health is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive—because diversity is core to who we are and critical to our work in health and wellbeing.

• Reviews cases in which clinical determinations cannot be made by the Initial Clinical Reviewer. • Discusses determinations with requesting physicians or ordering providers, when available, within the regulatory time frame of the request by phone or fax. • Provides clinical rationale for standard and expedited appeals. • Provides assistance and acts as a resource to Initial Clinical Reviewers as needed to discuss cases and problems. • Ensures documentation of all communications with medical office staff and/or physician/provider is recorded in a timely and accurate manner. • Participates in on-going inter-rater reliability training and testing • Assists the Medical Director and/or VP, Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines, and/or system support.