Clinical Pharmacist, Utilization Management

Summary

Join Rightway's PBM Clinical Operations team as a Clinical Pharmacist, Utilization Management, contributing to our mission of making drugs more affordable. You will support all lines of business by reviewing utilization management requests, ensuring clinical appropriateness and cost-effectiveness. Responsibilities include continual process review, coordination with other team members, adherence to guidelines, discussion with prescribers, participation in quality reviews, support of the P&T process, and development of clinical policies and programs. The ideal candidate possesses a Pharmacy Degree (PharmD preferred), 1+ year of experience coordinating medication selection, a pharmacist license, and strong communication and problem-solving skills. The position offers a base salary of $120,000-125,000, with potential for additional compensation based on location.

Requirements

• Education level: Pharmacy Degree Required, PharmD preferred
• Work experience: 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

Preferred: 1-3+ years of managed care (PBM or health plan) prior authorization experience

Benefits

BASE SALARY: $120,000-125,000