Remote Pharmacist: Utilization Management and PA Reviews

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

Job summary

Highmark Inc. is seeking a Pharmacist to perform utilization management for prior authorizations and appeals. You will evaluate clinical information against medical policy and make coverage determinations, often researching beyond policy to finalize decisions.

This is a remote role based in Pennsylvania. The position requires a PharmD or BS in Pharmacy, pharmacy licensure, and 1–3 years of pharmacy experience.

Qualifications

• Must be a registered Pharmacist.
• 1–3 years in pharmacy practice.
• Strong oral and written communication, computer skills, and problem solving.

Responsibilities

• Make coverage determinations by evaluating requests for prior authorization or appeals against medical policy through Utilization Review.
• Update system records to ensure claims are routed and paid correctly.
• Conduct research beyond medical policy review to support decisions.

Skills

Oral & written comms

General computer skills

Problem solving

Compliance

Prioritizing

Education

Bachelor's degree in Pharmacy

Doctorate in Pharmacy

Job description

Highmark Inc. is seeking a Pharmacist to perform utilization management for prior authorizations and appeals. You will evaluate clinical information against medical policy and make coverage determinations, often researching beyond policy to finalize decisions.

This is a remote role based in Pennsylvania. The position requires a PharmD or BS in Pharmacy, pharmacy licensure, and 1–3 years of pharmacy experience.