Remote Pharmacist, Utilization Management & Clinical Policy

Archimedes; Madison (WI); Remote; USD 110,000 - 160,000; Full time

Benefits offered by this job

Health, Dental, and Vision 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

Professional Membership assistance

Referral Bonus Program – up to $750

Job summary

Archimedes in Wisconsin seeks a Pharmacist, Clinical Utilization Management to lead utilization management for specialty medications across pharmacy and medical benefits. You will engage with physicians, nurses, and pharmacists to optimize prior authorizations, high-cost case reviews, and therapeutic substitutions, while analyzing data to shape clinical policies.

Responsibilities include peer-to-peer consultations, clinical outreach, and presenting cost-effectiveness information to plan

Qualifications

• Bachelor’s degree in Pharmacy or PharmD is required.
• Current, unrestricted Pharmacist license in the state of residence or reciprocity within 4 months.
• Experience in pharmacy settings and benefits programs preferred.
• Proficiency with Microsoft Office applications required.

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.
• Engage in evidence-based clinical conversations to explain utilization criteria and alternatives.
• Serve as a clinical resource for member-facing teammates and support for inquiries.
• Present deep clinical and cost-effectiveness information as a subject matter expert.
• Other duties as assigned.

Skills

Clinical communication

Managed care experience

Prior authorization

Team collaboration

Education

Bachelor’s degree in Pharmacy or PharmD

Tools

Microsoft Excel

PowerPoint

Word

Job description

Archimedes in Wisconsin seeks a Pharmacist, Clinical Utilization Management to lead utilization management for specialty medications across pharmacy and medical benefits. You will engage with physicians, nurses, and pharmacists to optimize prior authorizations, high-cost case reviews, and therapeutic substitutions, while analyzing data to shape clinical policies.

Responsibilities include peer-to-peer consultations, clinical outreach, and presenting cost-effectiveness information to plan