Remote Clinical Pharmacist, Utilization Management

Summary

Join our team as a Clinical Pharmacist, Utilization Management to help clients better manage pharmacy spend and make drugs more affordable for their employees and dependents.

Requirements

• Pharmacy Degree Required, PharmD preferred
• 1 year experience coordinating medication selection with prescribers and their care teams. Preferred: 1-3+ years of managed care (PBM or health plan) prior authorization experience
• Pharmacist license in good standing in state of residence. Willingness to achieve and maintain licensure in multiple states (if needed)

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

Benefits

Base salary: $120,000-128,000