Remote Pharmacy Utilization Management Specialist

Point32Health, Inc.; Boston (MA); Hybrid; USD 34,000 - 50,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Retirement plans

Paid time off

Life and disability insurance

Tuition program

Well-being benefits

Comprehensive benefits package

Job summary

Point32Health is seeking a Pharmacy Utilization Management (UM) Specialist to set up and process drug prior authorization requests. You will review cases for regulatory compliance and document notes for pharmacist/medical director review.

Responsibilities include running test claims, communicating with providers, handling ePA requests, and performing quality checks. Remote work possible as needed.

Qualifications

• Certified Pharmacy Technician (CPhT) credential required.
• HS diploma or GED; an Associate's degree in healthcare or related field preferred.
• Minimum 2 years of pharmacy experience; managed care/PBM experience preferred.
• Experience with RxClaims and PAHub systems.

Responsibilities

• Set up and process cases for drug prior authorization requests.
• Review cases to ensure regulatory and accreditation requirements are met.
• Document case notes for PAs requiring pharmacist or medical director review.
• Run test claims for approved authorizations; contact members/providers as needed.
• Communicate with providers to process phone PAs and address inquiries.
• Conduct daily quality checks; manage the UM team email box and ePA requests.

Skills

MS Office proficiency (Excel, Word, Pn

Attention to detail

Independent work

Teamwork

Communication

Medical terminology

Education

High School Diploma or GED

Associate's degree in Healthcare or related

Tools

RxClaims

PAHub

Job description

Point32Health is seeking a Pharmacy Utilization Management (UM) Specialist to set up and process drug prior authorization requests. You will review cases for regulatory compliance and document notes for pharmacist/medical director review.

Responsibilities include running test claims, communicating with providers, handling ePA requests, and performing quality checks. Remote work possible as needed.