Medicaid Pharmacist — Policy & Prior Authorization

Utah Division of Human Resource Management; Salt Lake City (UT); Hybrid; USD 59,000 - 89,000; Full time

Benefits offered by this job

Full benefits package

Hybrid work arrangement

In-office Monday/Tuesday presence

Job summary

Utah Medicaid Pharmacist DHHS is a full-time/hybrid role focused on developing and overseeing pharmacy coverage policies and prior authorization criteria. The pharmacist will review clinical information, analyze claims, and stay current with Medicaid pharmacy program requirements to ensure safe, effective medications for members.

The position requires Utah licensure, strong communication, and data interpretation skills, with a hybrid in-office/remote schedule and a competitive benefits package.

Qualifications

• Must reside in Utah and be available to work in-office on Mondays and Tuesdays; hybrid schedule subject to change.
• Must hold a current and active pharmacist license in good standing in the State of Utah.
• Knowledge of pharmacotherapy, clinical pharmacy practice, and evidence-based treatment guidelines; experience evaluating literature and drug information.
• Ability to review clinical information and apply established criteria to determine medical necessity and medication coverage.
• Strong written and verbal communication skills; organize and document clinical information for accurate records.

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 by evaluating patient information against policy criteria and guidelines.
• Evaluate and interpret literature and guidelines to support policy decisions.
• Analyze pharmacy and medical claims data to identify trends and opportunities for program improvement.
• Collaborate with internal teams and participate in workgroups to support program initiatives.

Skills

Pharmacotherapy

Clinical pharmacy

Evidence-based guidelines

Communication skills

Data analysis

Education

Utah Pharmacist License

Tools

PDL knowledge

DUR processes

Job description

Utah Medicaid Pharmacist DHHS is a full-time/hybrid role focused on developing and overseeing pharmacy coverage policies and prior authorization criteria. The pharmacist will review clinical information, analyze claims, and stay current with Medicaid pharmacy program requirements to ensure safe, effective medications for members.

The position requires Utah licensure, strong communication, and data interpretation skills, with a hybrid in-office/remote schedule and a competitive benefits package.