PBM Utilization Pharmacist — Fast-Paced Clinical Decisions

Unitas; Town of River Falls (WI); Hybrid; USD 90,000 - 130,000; Full time

Job summary

UNITAS in Wisconsin is seeking an Utilization Management Pharmacist to review prior authorizations and support clinical programs. This role blends clinical decision-making with a strong focus on service delivery in a fast-paced, collaborative environment.

You will document decisions, stay current with guidelines, and ensure compliance across Commercial, Exchange, Medicare, and Medicaid plans. After-hours and weekend coverage is required on a rotating schedule.

Qualifications

• Doctor of Pharmacy or PharmD required.
• Minimum 2 years of pharmacy practice experience.
• Strong written and oral communication skills.
• Ability to manage multiple priorities in a high-volume setting.
• Availability to work after hours, weekends, and holidays on rotating schedule.

Responsibilities

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

Skills

Communication skills

Organizational skills

After-hours availability

Education

Doctor of Pharmacy degree

Bachelor’s degree in Pharmacy

Job description

UNITAS in Wisconsin is seeking an Utilization Management Pharmacist to review prior authorizations and support clinical programs. This role blends clinical decision-making with a strong focus on service delivery in a fast-paced, collaborative environment.

You will document decisions, stay current with guidelines, and ensure compliance across Commercial, Exchange, Medicare, and Medicaid plans. After-hours and weekend coverage is required on a rotating schedule.