Clinical Utilization Management Pharmacist

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

📋 Description

• Conduct drug utilization reviews for initial determinations and/or appeals for ASO clients and Medicare Advantage plans.

• Collaborate effectively as a key member of the pharmacy team.

• Act as a subject matter expert in pharmacy utilization management.

• Ensure the prompt execution of all drug reviews in accordance with accreditation and regulatory standards.

• Partner with the Medical Director and Clinical Formulary team to evaluate specialty medications that necessitate a consult.

⛳️ Requirements

• Must hold a current and unrestricted pharmacy license issued by the state of residence.

• A minimum of three (3) years of experience as a pharmacist in a clinical environment.

• At least two (2) years of experience in managed care.

• In-depth knowledge of CMS regulations, HIPAA, and the regulatory framework.

🏝️ Benefits

• Standard office environment

• Some travel may be necessary for offsite meetings