Clinical Pharmacist – Utilization Management

Rightway Healthcare; New York (NY); On-site; USD 120,000 - 125,000; Full time

Job summary

Rightway Healthcare is hiring a Clinical Pharmacist, Utilization Management to join our PBM Clinical Operations team in New York. You will review UM requests, ensure compliant PBM service delivery, and coordinate with pharmacists, technicians, and medical directors across UM activities.

The role emphasizes evidence-based decision making, collaboration with prescribers, and participation in quality and P&T processes.

Qualifications

• Pharmacy degree required; PharmD preferred.
• 1 year coordinating medication selection with prescribers.
• Preferred 1–3+ years in managed care / PBM prior authorization.
• Licensed pharmacist in good standing; multi-state licensure possible.
• Available to work 40 hours per week with possible evenings/weekends.
• Detail-oriented, analytical, empathetic with strong listening skills.
• Ability to influence others even without direct reporting lines.

Responsibilities

• Review utilization management requests for coverage that are clinically appropriate and cost effective.
• Continuously review UM processes to ensure compliant delivery of PBM services.
• Coordinate with Pharmacy technicians, Pharmacists, and Medical Directors on UM activities.
• Ensure cases are reviewed in accordance with State and Federal guidelines including turnaround time requirements.
• Discuss clinical strategy and decision rationale with prescribers as needed.
• Participate in the quality review and inter-rater reliability processes.
• Support P&T processes including the development of therapeutic class/drug monographs as needed.
• Research and develop therapy-specific clinical policies and UM programs such as Prior Authorization, Step Therapy, Quantity Limit, and Coverage Determination.

Skills

Pharmacy benefit knowledge

Problem-solving

Change management

Communication skills

Project leadership

Education

Pharmacy degree required

PharmD preferred

Job description

Rightway Healthcare is hiring a Clinical Pharmacist, Utilization Management to join our PBM Clinical Operations team in New York. You will review UM requests, ensure compliant PBM service delivery, and coordinate with pharmacists, technicians, and medical directors across UM activities.

The role emphasizes evidence-based decision making, collaboration with prescribers, and participation in quality and P&T processes.