Clinical Pharmacist: Utilization & Formulary Expert

CommunityCare HMO Inc.; Tulsa (OK); Remote; USD 110,000 - 150,000; Full time

Job summary

CommunityCare HMO Inc. seeks a Utilization Management Clinical Pharmacist to optimize medication use, support formulary development, and ensure regulatory compliance across medical injectable and specialty therapies.

You will review prior authorization requests, approve or deny within turnaround targets, and collaborate with pharmacy technicians, medical directors, and clinicians to drive evidence-based decisions.

Qualifications

• PharmD or PharmD-equivalent with Oklahoma licensure or eligible.
• Minimum five years in managed care or PBM settings.
• Experience reviewing prior authorization for medical injectable and specialty meds preferred.

Responsibilities

• Review prior authorization requests for medical injectable, specialty, and high-cost meds.
• Approve or deny requests within turnaround times while ensuring clinical appropriateness.
• Collaborate with technicians, medical directors, and clinicians on UM decisions.
• Provide clinical consultation on complex requests and determinations.
• Support development, implementation, and maintenance of UM programs.
• Develop and maintain evidence-based criteria, policies, and guidelines.
• Perform annual policy reviews and update criteria based on evidence and guidelines.
• Monitor new drug approvals and recommend UM strategies.
• Support MTM program and conduct Comprehensive Medication Reviews as needed.
• Perform pharmacy case management to identify problems and interventions.
• Develop educational materials for providers and internal stakeholders.
• Participate in provider outreach and academic detailing focused on evidence-based prescribing.
• Support provider newsletters, educational programs, and clinical training initiatives.
• Perform other related duties as required, including on-call coverage.

Skills

Managed care pharmacy

Utilization management

Formulary management

Medicare knowledge

Pharmacy benefit management

Clinical decision making

Communication skills

Collaboration

Microsoft Office

Pharmacy information systems

Education

PharmD or BS in Pharmacy

Tools

Pharmacy information systems

PBM software

Job description

CommunityCare HMO Inc. seeks a Utilization Management Clinical Pharmacist to optimize medication use, support formulary development, and ensure regulatory compliance across medical injectable and specialty therapies.

You will review prior authorization requests, approve or deny within turnaround targets, and collaborate with pharmacy technicians, medical directors, and clinicians to drive evidence-based decisions.