Remote PBM Utilization Pharmacist

Clinical Consulting Solutions; Town of River Falls (WI); Remote; USD 125,000 - 130,000; Full time

Job summary

Clinical Consulting Solutions, a nationwide clinical staffing firm, is seeking a PBM Utilization Management Pharmacist (Remote). You will review prior authorizations and support clinical programs in a fast-paced, collaborative environment.

Requirements include a PharmD or Bachelor’s degree, an active pharmacist license, and 2+ years of practice. The role offers remote work in the United States with a pay range of $125,000–$130,000 per year.

Qualifications

• Pharmacist degree and license required.
• 2+ years of pharmacy practice experience.
• Excellent communication and organization.

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

Skills

Strong communication

Writing skills

Organizational skills

Education

Bachelor’s or PharmD degree

Active, unrestricted pharmacist license

Job description

Clinical Consulting Solutions, a nationwide clinical staffing firm, is seeking a PBM Utilization Management Pharmacist (Remote). You will review prior authorizations and support clinical programs in a fast-paced, collaborative environment.

Requirements include a PharmD or Bachelor’s degree, an active pharmacist license, and 2+ years of practice. The role offers remote work in the United States with a pay range of $125,000–$130,000 per year.