Hybrid Utah Medicaid Pharmacist — Policy & Prior Authorization

Utah Department of Human Resource Management (DHRM); Salt Lake City (UT); Hybrid; USD 89,000 - 134,000; Full time

Benefits offered by this job

Full benefits package

Hybrid work schedule

Job summary

Utah Department of Health and Human Services (DHHS) is seeking a Pharmacist to support Medicaid pharmacy coverage policy, prior authorization criteria, and clinical reviews. The role emphasizes maintaining compliance, evaluating requests, and collaborating across teams to ensure safe and effective medication access for Medicaid members.

The position is hybrid, requiring in-office presence on some days, with remote work options subject to agency policy.

Qualifications

• Must reside in Utah and be available for in-office Mondays and Tuesdays.
• Active Utah pharmacist license in good standing.
• Knowledge of pharmacotherapy, clinical practice, and evidence-based guidelines.
• Ability to review clinical information and determine medical necessity for coverage.
• Strong written and verbal communication skills.

Responsibilities

• Develop, implement, and maintain pharmacy coverage policies and clinical prior authorization criteria.
• Review and evaluate prior authorization requests for clinical appropriateness and necessity.
• Perform comprehensive clinical reviews against policy criteria and guidelines.
• Analyze pharmacy and medical claims data to identify trends for program improvement.
• Collaborate with internal teams on workgroups and maintain an audit trail.

Skills

Pharmacotherapy

Clinical guidelines

Evidence-based medicine

Communication

Policy review

Education

Utah Pharmacist license (active)

Tools

DUR processes

PDL familiarity

Claims data analysis

Job description

Utah Department of Health and Human Services (DHHS) is seeking a Pharmacist to support Medicaid pharmacy coverage policy, prior authorization criteria, and clinical reviews. The role emphasizes maintaining compliance, evaluating requests, and collaborating across teams to ensure safe and effective medication access for Medicaid members.

The position is hybrid, requiring in-office presence on some days, with remote work options subject to agency policy.