Clinical Pharmacist- Utilization Management

remote work; United States; Remote; USD 95,000 - 120,000; Full time

Job summary

Rightway is seeking a Clinical Pharmacist, Utilization Management to support UM leadership, review UM requests, and help deliver PBM services to clients. You will coordinate with pharmacy technicians, pharmacists, and medical directors to ensure timely, cost-effective coverage.

The role requires a pharmacy degree (PharmD preferred), 1 year coordinating with prescribers, and 1–3+ years in managed care PBM or health plan prior authorization.

Qualifications

• Pharmacy degree required; PharmD preferred.
• 1 year experience coordinating medication selection with prescribers.
• 1-3+ years of managed care PBM or health plan prior authorization experience preferred.
• Licensed Pharmacist in good standing in state of residence.
• Willingness to achieve licensure in multiple states if needed.
• Available to work 40 hours per week with core hours 8 am to 8 pm Eastern.

Responsibilities

• Review utilization management requests for appropriate and cost effective coverage.
• Continually review UM operational processes for compliant delivery.
• Coordinate with Pharmacy technicians, Pharmacists, and Medical Directors on UM activities.
• Ensure reviews meet State and Federal guidelines including turnaround times.
• Discuss clinical strategy with prescribers as needed.
• Support P and T processes and develop therapy specific policies as needed.

Skills

Pharmacy degree

Pharmacist coordination with prescrib?

Education

Pharmacy degree

PharmD preferred

Job description

About the role

Rightway operates a new to the world PBM model aimed at fairness and transparency in pharmacy spend. The Clinical Pharmacist, Utilization Management supports UM leadership, reviews utilization management requests, and helps deliver PBM services to clients.

What you'll do

• Review utilization management requests for appropriate and cost effective coverage
• Continually review UM operational processes for compliant delivery
• Coordinate with Pharmacy technicians, Pharmacists, and Medical Directors on UM activities
• Ensure reviews meet State and Federal guidelines including turnaround times
• Discuss clinical strategy with prescribers as needed
• Support P and T processes and develop therapy specific policies as needed

What they're looking for

• Pharmacy degree required, PharmD preferred
• 1 year experience coordinating medication selection with prescribers
• 1-3+ years of managed care PBM or health plan prior authorization experience preferred
• Licensed Pharmacist in good standing in state of residence
• Willingness to achieve/licensure in multiple states if needed
• Available to work 40 hours per week with core hours 8 am to 8 pm Eastern and potential future shifts

For applicants in Nigeria

• The listing does not specify a timezone requirement; confirm during interview
• The listing does not state timezone expectations or whether remote work is allowed for Nigeria; confirm during interview
• The listing does not state visa or work-authorization notes; confirm during interview