Clinical Utilization Management Pharmacist

Responsibilities

• Perform drug utilization reviews for initial determinations and appeals
• Participate in the appeals process related to drug reviews
• Manage the operational execution of the drug review process
• Act as a subject matter expert for pharmacy utilization management
• Collaborate with management to ensure timely and compliant drug reviews
• Identify trends and policy needs in drug utilization reviews
• Assist in claims data analysis to evaluate formulary effectiveness

Qualifications

• Current and unrestricted pharmacy license in the state of residence
• Minimum of three years of clinical pharmacy experience
• At least two years of experience in managed care
• Knowledge of CMS regulations and HIPAA compliance (preferred)

Benefits

• Engagement in a dynamic team environment focused on clinical pharmacy
• Opportunity to influence utilization management processes and policy
• Hands-on experience with specialty medication consultations
• Involvement in training and precepting pharmacy residents and students
• Potential for professional development through analysis and strategic initiatives

Pay

$100,000 – $130,000 annually

Schedule

Remote - US based candidates only, no visa sponsorship available

Company Information

Our client is an equal opportunity employer. We encourage you to apply even if you don’t meet every qualification—your background could be exactly what this team needs.