1mo ago

Clinical Utilization Management Pharmacist

Remotemid
HealthcarePharmacist
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Quick Summary

Requirements Summary

EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. Must possess current and unrestricted license to practice pharmacy issued by state of residence. EXPERIENCE: 1.

Technical Tools
HealthcarePharmacist

About the Role

~1 min read

Reporting to the Manager of Clinical Pharmacy, the Clinical Utilization Management Pharmacist is primarily responsible for performing drug utilization review for initial determinations and/or appeals for our ASO clients, Medicare Advantage plan, and any future lines of business as well as collaborating as an integral member of the pharmacy team. The responsibilities of this position also include serving as a subject matter expert for pharmacy utilization management in addition to ensuring the timely execution of all drug reviews in compliance with accreditation and regulatory standards. In addition, the Clinical Utilization Management Pharmacist will work with our Medical Director and Clinical Formulary team to review any specialty medication requiring a specialty consult as defined by our formulary team and identify any utilization review trends and areas of improvement that need to be addressed.

Requirements

~1 min read

1. Must possess current and unrestricted license to practice pharmacy issued by state of residence.

1. Specific knowledge of CMS regulations, HIPAA and regulatory environment.

1. Three (3) years of experience as a pharmacist in a clinical setting.

2. Two (2) years of managed care experience.

Responsibilities

~1 min read

1. Ability to work under stressful working conditions.

2. Ability to handle and maintain confidential information.

3. Ability to work cooperatively as a team member with articulate communication and presentation skills.

4. Ability to work in a fast-paced and rapidly changing environment.

5. Ability to work proactively and independently to research and resolve issues.

6. Extensive working knowledge of Microsoft Office applications (Excel and Access).

United States of America (Exempt)

2405 PHH Medication Management

Location & Eligibility

Where is the job
Worldwide
Fully remote, anywhere in the world
Who can apply
Same as job location

About this job

Posted
34 days ago
Employer
has 3,618 open jobs on Jobera.

Listing Details

Posted
September 21, 2026
First seen
September 30, 2026
Last seen
October 24, 2026

Posting Health

Days active
24
Repost count
0
Trust Level
27%
Scored at
October 25, 2026

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Clinical Utilization Management Pharmacist
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