Clinical Pharmacist, Utilization Management

Summary

Join Rightway's PBM Clinical Operations team as a Clinical Pharmacist, Utilization Management! You will support all lines of business by reviewing utilization management requests, ensuring clinical appropriateness and cost-effectiveness. Responsibilities include process review, coordination with other team members, adherence to guidelines, and collaboration with prescribers. You will also contribute to policy development and participate in quality review processes. This role requires a Pharmacy Degree (PharmD preferred), experience coordinating medication selection, and a pharmacist license. Rightway offers a competitive salary and a supportive work environment.

Requirements

• Pharmacy Degree Required, PharmD preferred
• 1 year experience coordinating medication selection with prescribers and their care teams
• Pharmacist license in good standing in state of residence.  Willingness to achieve and maintain licensure in multiple states (if needed)
• Available to work 40 hours/week.  Core operating hours are weekdays within 8 am Eastern Time and 8 pm Eastern Time, but may be required to work evening and/or weekend shifts in the future as Rightway grows.  On call approximately once every two months

Responsibilities

• Support all lines of business via reviewing utilization management requests for coverage that are clinically appropriate and cost effective
• Continual review of UM operational processes to ensure effective and compliant delivery of PBM services to our clients
• Coordinate with Pharmacy technicians, Pharmacists, and/or Medical Directors on UM activities
• Ensure cases are reviewed in accordance with State and/or Federal guidelines including turnaround time requirements
• As needed, discuss clinical strategy and decision rationale with prescribers
• Participate in the quality review and inter-rater reliability processes
• Supports P&T process including the development of therapeutic class/drug monographs as needed
• Research and develop therapy-specific clinical policies and utilization management programs such as Prior Authorization, Step Therapy, Quantity Limit, and/or Coverage Determination programs
• Support Clinical Operations leadership and coordinate with Pharmacy Navigation team as needed

Preferred Qualifications

• 1-3+ years of managed care (PBM or health plan) prior authorization experience
• Detail-oriented, intellectually and clinically curious, good listener, empathetic, ability to challenge status quo, values exemplar
• Great pharmacy benefit knowledge, effective & creative problem-solver, ability to prioritize and manage through change. Solid communication skills, ability to lead projects and influence others even without direct reporting line ownership

Benefits

BASE SALARY: $120,000-128,000