Lead Utilization Management Pharmacist (Fully Remote)

Judi Health, LLC; United States; Remote; USD 110,000 - 170,000; Full time

Job summary

Judi Health, LLC is seeking a Lead Utilization Management Pharmacist to oversee daily clinical pharmacy functions and ensure efficient processing of medication requests in a remote work setting across the United States. The role requires an active pharmacist license (PharmD) or equivalent and 2+ years of experience, with experience in prior authorization and call centers.

You will collaborate with business and clinical partners to improve workflows while meeting regulatory and internal

Qualifications

• Active, unrestricted pharmacist license and Doctor of Pharmacy or Bachelor's degree with 2+ years of experience.
• Experience in customer service, call center, and prior authorization.
• Ability to work independently in a remote, metric-driven environment.

Responsibilities

• Lead Utilization Management Pharmacist overseeing daily clinical pharmacy functions.
• Perform prior authorization reviews, appeal reviews, and override requests.
• Collaborate with business and clinical partners to improve workflows and ensure consistency.
• Monitor queues to meet regulatory and internal compliance requirements.

Skills

Customer service

Prior authorization

Education

Doctor of Pharmacy

Bachelor's degree

Job description

• Lead Utilization Management Pharmacist overseeing daily clinical pharmacy functions.
• Ensure efficient processing of medication requests while adhering to medical necessity and contractual criteria.
• Support and guide Utilization Management pharmacists to maintain high-quality performance.

Key Responsibilities:

• Perform prior authorization reviews, appeal reviews, and override requests.
• Collaborate with business and clinical partners to improve workflows and ensure consistency.
• Monitor queues to meet regulatory and internal compliance requirements.

Qualifications:

• Active, unrestricted pharmacist license and Doctor of Pharmacy or Bachelor's degree with 2+ years of experience.
• Experience in customer service, call center, and prior authorization.
• Ability to work independently in a remote, metric-driven environment.

Work Requirements:

• Must have a secure, quiet workspace and wired internet connection.
• Able to work 2p-11p ET shift with weekend and holiday rotation.

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. It replaces fragmented systems with a unified claims processing platform and uses AI-powered care delivery to serve millions of Americans, fostering a mission-driven, collaborative culture.