Remote Lead Pharmacist, Utilization Management

Capital Rx Inc.; États-Unis; À distance; USD 134 000 - 146 000; Plein temps

Résumé du poste

Judi Health is seeking a Lead Utilization Management Pharmacist to oversee daily clinical pharmacy operations, including prior authorization reviews, overrides, and member/provider education. You will guide the UM team to ensure medical necessity and contract criteria are met while aligning with client requirements.

You will collaborate with clinical and business partners to improve workflows, support training, and lead projects that enhance care quality and cost effectiveness.

Qualifications

• Active, unrestricted pharmacist license.
• 2+ years of pharmacy practice experience.
• Experience in customer service, call center and prior authorization.
• Excellent communication, writing, and organizational skills.
• Ability to work independently with minimal supervision in a remote, high-volume call center environment.
• Self-motivated and detail-oriented problem solver.

Responsabilités

• Oversee day-to-day clinical pharmacy functions including prior authorization reviews and appeals.
• Educate members and providers via calls.
• Train and develop staff.
• Collaborate with cross-functional teams to improve workflows.
• Lead projects to improve pharmacy operations and outcomes.
• Provide SME on clinical medication reviews and consultations.
• Monitor regulatory and contract compliance in reviews.
• Review pharmacy claims data for proactive outreach.
• Identify and mitigate inappropriate care trends.

Connaissances

Customer service experience

Call center experience

Prior authorization knowledge

Excellent communication

Written communication

Independence in remote setting

Team collaboration

Multitasking

Formation

Bachelor of Pharmacy

Doctor of Pharmacy (PharmD)

Outils

MS Office

Description du poste

Judi Health is seeking a Lead Utilization Management Pharmacist to oversee daily clinical pharmacy operations, including prior authorization reviews, overrides, and member/provider education. You will guide the UM team to ensure medical necessity and contract criteria are met while aligning with client requirements.

You will collaborate with clinical and business partners to improve workflows, support training, and lead projects that enhance care quality and cost effectiveness.