Eric Saul

About Eric Saul

Utilization Management Clinical Pharmacist | Medicare • Medicaid • Commercial | PA, Appeals, Policy & QA | Provider EngagementClinical Pharmacist with 20+ years of experience across managed care, utilization management, specialty pharmacy, retail, long-term care, pediatric inpatient, and primary care medical office settings. I specialize in patient-centered care, clinical policy development, and utilization management, with deep experience in prior authorization, medical necessity review, appeals support, and formulary management across Medicare, Medicaid, Commercial, and Exchange lines of business.I partner closely with prescribers, medical directors, care management, compliance, and operational teams to ensure safe, appropriate, and cost-effective medication use. My work centers on guideline-based reviews, provider callbacks, and collaborative clinical decision-making that improves outcomes while maintaining regulatory compliance and case consistency.Beyond clinical review, I’ve led account management and vendor relations efforts, helping align PBMs, specialty pharmacies, and provider groups to deliver high-quality care. I bring hands-on experience with UM and claims platforms including CPR+, PDX, OptumRx RxAuth/RxClaim, Therigy, and REMS programs, and I’m known for translating complex clinical criteria into practical workflows for frontline teams.Highlights of my background include:• Utilization management, prior authorization, and medical necessity reviews• Clinical policy creation, decision criteria, and formulary management• Provider engagement, medical director support, and interdisciplinary collaboration• Quality assurance, audit support, and compliance-focused documentation• Oncology and pediatric behavioral health medication management• Account management, vendor partnership, and operational process improvementI’m passionate about building strong clinical partnerships, mentoring teammates, and continuously improving UM processes to deliver better member outcomes with integrity and efficiency.

Experience

1. Pharmacy Um Clinical Pharmacist Ii

   CDPHP

   Apr 2025 — Present

   Working in pharmacy department to assist with clinical utilization reviews of prior authorization requests. Continued cross departmental work with areas focused on pediatric behavioral health, high utilizing members and pharmacy medical claims issues involvement payment disputes and payment integrity issues. Resumed ownership of the clinical algorithm writing to allow pharmacy technicians to review and approve requests.

Education

• University at Buffalo Pharmacy and Pharmaceutical Sciences

  Bachelor of Science (BS), Pharmacy

  1993 — 1998

Skills

• Policy Writing
• Diabetes
• Long-Term Care
• Prior Authorization
• Microsoft Office
• Pharmacists
• Pharmacy Practice
• Office 365
• Inpatient
• Managed Care
• Pharmacueticals
• Pharmaceutics
• Oncology
• Clinical Pharmacy
• Microsoft Powerpoint
• Healthcare
• Information Graphics
• Clinical Pharmacology
• Pharmacy Automation
• Medication Therapy Management
• Pediatrics
• Communication
• Presentations
• Personal Finance
• Patient Counseling
• Pharmacy
• Pharmacy Benefit Management
• Pharmaceutical Industry