Clinical Pharmacist – Utilization Management

This is a fully remote position, open to applicants in Florida.

📋 Description

• Assist all business sectors by evaluating utilization management requests for clinically suitable and cost-efficient coverage.

• Consistently assess UM operational procedures to guarantee effective and compliant provision of PBM services.

• Collaborate with Pharmacy Technicians, Pharmacists, and/or Medical Directors on UM activities.

• Ensure that cases are evaluated in accordance with state and federal regulations, including turnaround-time mandates.

• Engage in discussions regarding clinical strategies and decision justifications with prescribers as necessary.

• Take part in quality review and inter-rater reliability initiatives.

• Contribute to the P&T process, which includes creating therapeutic class/drug monographs as required.

• Investigate and formulate therapy-specific clinical policies and utilization management programs, such as Prior Authorization, Step Therapy, Quantity Limit, and Coverage Determination programs.

• Provide support to Clinical Operations leadership and coordinate with the Pharmacy Navigation team as required.

⛳️ Requirements

• Pharmacy Degree is mandatory; PharmD is preferred.

• Minimum of 1 year experience in coordinating medication selection with prescribers and their care teams.

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

• Active pharmacist license in good standing in the state of residence.

• Willingness to obtain and maintain licensure in multiple states (if necessary).

• Availability to work 40 hours per week.

• Core operating hours are weekdays between 8 am Eastern Time and 8 pm Eastern Time.

• Detail-oriented, intellectually and clinically inquisitive, good listener, empathetic, capable of challenging the status quo, and values exemplary performance.

• Strong knowledge of pharmacy benefits.

• Effective and innovative problem-solving skills.

• Ability to prioritize tasks and manage through changes.

• Strong communication abilities.

• Capability to lead projects and influence others without direct reporting-line authority.

🏝️ Benefits

• Bonus.

• Equity.

• Potential evening and/or weekend shifts as Rightway expands.

• On-call approximately once every two months.