Remote Utilization Management Pharmacist – PBM Expert

Judi Health; Poland; Remote; PLN 473,843 - 492,797; Full time

Job summary

Judi Health is seeking a Utilization Management Pharmacist for a remote role, focusing on prior authorizations, clinical program support, and guidance to members, providers, and pharmacies.

The position blends clinical decision-making with service excellence in a fast-paced team, requiring a PharmD or bachelor's degree and 6–12 months in authorization or utilization management, plus PBM or managed care exposure.

Qualifications

• Minimum 6–12 months of prior authorization or utilization management experience.
• Pharmacy degree (PharmD or B.Pharm) required.
• Minimum 2 years of pharmacy practice experience.
• Experience in managed care or PBM.
• Strong written and verbal communication skills.
• Ability to manage multiple priorities in a fast-paced, metric-driven environment.
• Willingness to work after hours, weekends, and holidays on a rotating schedule.

Responsibilities

• Review and decide on prior authorizations, appeals, and overrides using guidelines.
• Ensure compliance with applicable regulations across plans.
• Document clinical decisions thoroughly per URAC/NCQA standards.
• Provide empathetic support to members, prescribers, and pharmacies via phone.
• Stay current with prescribing guidelines and internal policies.
• Protect patient privacy following HIPAA guidelines.
• Identify and report potential fraud, waste, and abuse.
• Assist leadership with special projects and process improvements.

Skills

Prior authorization experience

Communication

Organizational skills

Multitasking

Education

Bachelor's or Doctor of Pharmacy degree

Job description

Judi Health is seeking a Utilization Management Pharmacist for a remote role, focusing on prior authorizations, clinical program support, and guidance to members, providers, and pharmacies.

The position blends clinical decision-making with service excellence in a fast-paced team, requiring a PharmD or bachelor's degree and 6–12 months in authorization or utilization management, plus PBM or managed care exposure.