Remote Pharmacist, Clinical Utilization Management

Navitus Health Solutions, LLC; United States; Remote; USD 110,000 - 160,000; Full time

Benefits offered by this job

Health insurance

20 days paid time off

4 weeks paid parental leave

9 paid holidays

401K company match 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan

Referral Bonus Program – up to $750

Job summary

Archimedes is seeking a Pharmacist, Clinical Utilization Management to join our team. The Pharmacist will be the clinical expert for all specialty medications across pharmaceutical and medical benefits, communicating with physicians, nurses, pharmacists, and members regarding high-cost case concerns and cost management.

The role includes two focus areas: external clinical outreach for high-cost case management and prior authorization of specialty medications, across pharmacy and medical

Qualifications

• Bachelor’s degree in Pharmacy or PharmD required.
• Current, unrestricted pharmacist license in the resident state.
• Pharmacy experience in retail, hospital, managed care, or related setting preferred.
• Experience with physician-facing clinical communication preferred.

Responsibilities

• Develop and deliver clinical messages to physicians, members, clients, and consultants.
• Manage prior authorization, high-cost cases, claims editing and clinical policy development.
• Conduct prior authorization outreach to prescribers to obtain clinical information and support timely case resolution.
• Communicate with prescribers and other clinical stakeholders by phone, email, or fax regarding prior authorization requests and benefit requirements.
• Engage in evidence-based clinical conversations with prescribers to explain utilization management criteria and coverage determinations.

Skills

Physician communication

Teamwork

Education

Pharmacy degree or PharmD

Licensed pharmacist (state of residence)

Tools

Microsoft Excel

PowerPoint

Word

Job description

Archimedes is seeking a Pharmacist, Clinical Utilization Management to join our team. The Pharmacist will be the clinical expert for all specialty medications across pharmaceutical and medical benefits, communicating with physicians, nurses, pharmacists, and members regarding high-cost case concerns and cost management.

The role includes two focus areas: external clinical outreach for high-cost case management and prior authorization of specialty medications, across pharmacy and medical