Remote Pharmacist - Utilization Management

Highmark Health; Northern (KY); Hybrid; USD 103,000 - 165,000; Full time

Job summary

Highmark Inc. seeks a Pharmacist for Utilization Management to evaluate medication coverage requests and prior authorizations, using medical policy criteria and clinical judgment to make determinations.

This remote role requires a Bachelor’s in Pharmacy with 1–3 years of pharmacy experience; a Doctorate in Pharmacy is preferred. You will document decisions, update systems, and conduct policy-based research to support coverage outcomes.

Qualifications

• Bachelor's degree in Pharmacy required.
• Doctorate in Pharmacy preferred.
• 1–3 years in Pharmacy required.

Responsibilities

• Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy.
• Update the system records to ensure claims are properly routed and paid.
• Conduct research beyond medical policy review to support medication coverage decisions.
• Perform other duties as assigned.

Skills

Oral & Written Communication Skills

General Computer Skills

Problem Solving & Decision Making

Compliance

Prioritizing

Education

Bachelor's degree in Pharmacy

Doctorate degree in Pharmacy

Job description

Highmark Inc. seeks a Pharmacist for Utilization Management to evaluate medication coverage requests and prior authorizations, using medical policy criteria and clinical judgment to make determinations.

This remote role requires a Bachelor’s in Pharmacy with 1–3 years of pharmacy experience; a Doctorate in Pharmacy is preferred. You will document decisions, update systems, and conduct policy-based research to support coverage outcomes.