Remote Clinical Pharmacist – Utilization Management

Excellus Health Plan Inc.; City of Rochester (NY); On-site; USD 110,000 - 198,000; Full time

Benefits offered by this job

Remote work option

Job summary

Excellus Health Plan Inc. in New York seeks a licensed pharmacist to support UM activities across Medicare, Commercial, Exchange, and Medicaid. The role focuses on quality, safety, and cost management of medications for members through medical management of drugs across benefits.

Levels I-III outline responsibilities for authorizations, reviews, audits, mentoring, and cross-functional collaboration to ensure compliant, high‑quality care while safeguarding member privacy and data integrity.

Qualifications

• Unrestricted and current NYS Licensed Pharmacist.
• Pharm.D. In lieu of a Pharm.D., a Bachelors in Pharmacy is required.
• Managed care experience is strongly preferred, especially utilization management.

Responsibilities

• Conducts drug prior authorization, exception and medical necessity reviews.
• Reviews accompanying clinical information for approval criteria.
• Supports providers and pharmacies to expedite member treatment.
• Maintains and updates decision criteria and denial language.
• Applies compliance standards and protects member privacy.

Skills

Customer service

Communication

Team collaboration

Attention to detail

Problem solving

Education

Pharm.D.

Bachelors in Pharmacy

NYS Licensed Pharmacist

Tools

Microsoft Word

Excel

Job description

Excellus Health Plan Inc. in New York seeks a licensed pharmacist to support UM activities across Medicare, Commercial, Exchange, and Medicaid. The role focuses on quality, safety, and cost management of medications for members through medical management of drugs across benefits.

Levels I-III outline responsibilities for authorizations, reviews, audits, mentoring, and cross-functional collaboration to ensure compliant, high‑quality care while safeguarding member privacy and data integrity.