PBM Utilization Management Pharmacist (REMOTE)

UNITAS; United States; Remote; USD 125,000 - 130,000; Full time

Job summary

UNITAS in the United States is seeking a Utilization Management Pharmacist to review prior authorizations, support clinical programs, and guide members, providers, and pharmacies. This role blends clinical decision-making with service excellence in a fast-paced, collaborative environment; requires pharmacy degree, license, and 2+ years of practice; remote work option noted as Remote.

The position emphasizes regulatory compliance (URAC/NCQA) and staying current with guidelines; strong

Qualifications

• Requires a PharmD or BS in Pharmacy with active license.
• 2+ years pharmacy practice experience.
• Strong written and verbal communication skills.
• Ability to manage multiple priorities in a fast-paced setting.
• Availability for after-hours, weekends, and holidays on rotating schedule.

Responsibilities

• Review and decide on prior authorization requests per guidelines.
• Ensure compliance with federal and state regulations across plans.
• Document clinical decisions and maintain records per URAC/NCQA.
• Provide expert guidance to members, prescribers, and pharmacies via phone.
• Stay current with prescribing guidelines and internal policies.
• Follow HIPAA and protect patient privacy.
• Identify fraud, waste, and abuse.
• Support training and development of team members.
• Assist leadership with special projects and process improvements.

Skills

Communication

Writing

Organization

Multitasking

Education

PharmD

Job description

UNITAS provides clinical staffing and consulting solutions, including contract staff augmentation, permanent talent recruiting, consulting, and clinical coaching. Our extensive experience includes Pharmacy Benefit Management, Long-Term Care, Retail Pharmacy, Hospital, and Leadership, enabling us to connect the best clinical talent with outstanding companies. We know clinicians because we are clinicians!

Position Summary:

The Utilization Management Pharmacist plays a vital role in promoting safe, effective, and appropriate medication use. This position is responsible for reviewing prior authorization requests, supporting clinical programs, and providing expert guidance to members, providers, and pharmacies. The role combines clinical decision-making with a strong focus on service excellence in a fast-paced, collaborative environment.

Position Responsibilities:

• Review and make timely, evidence-based decisions on prior authorizations, appeals, and override requests using clinical guidelines and benefit criteria.
• Ensure compliance with federal, state, and internal regulations across Commercial, Exchange, Medicare, and Medicaid plans.
• Accurately document clinical decisions and maintain thorough records in accordance with regulatory and accreditation (URAC/NCQA) utilization review standards.
• Provide clear, empathetic support to members, prescribers, and pharmacies by responding to clinical inquiries via phone, demonstrating professionalism, active listening, and a patient-centered approach.
• Stay current with clinical prescribing guidelines, internal policies, and regulatory changes, and apply them to daily responsibilities.
• Follow all internal procedures, job aids, and HIPAA guidelines to protect patient privacy and data security.
• Identify and report potential fraud, waste, and abuse.
• Support training and development of new and existing team members as needed.
• Assist leadership with special projects, process improvements, and operational initiatives

Minimum Qualifications:

• Bachelor’s or Doctor of Pharmacy degree
• Active, unrestricted, pharmacist license
• Minimum of 2 years of pharmacy practice experience
• Strong communication, writing, and organizational skills
• Ability to manage multiple priorities in a high-volume, metric-driven environment
• Availability to work after hours, weekends, and holidays on a rotating schedule

Preferred Qualifications:

• Call center experience
• Minimum of 6 months prior authorization or utilization management experience
• Experience in managed care or pharmacy benefit management (PBM)

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

The pay range for this role is: 125,000 - 130,000 USD per year (Remote)