Remote Pharmacy Utilization Management Specialist

P32HS Point32Health Services Inc; Massachusetts; 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

Job summary

Point32Health is hiring a Pharmacy Utilization Management (UM) Specialist to set up and process drug prior authorization requests. You will review cases for regulatory compliance, document notes, and run test claims while coordinating with providers and members.

The role requires a CPhT certification, 2+ years of pharmacy experience, and strong MS Office skills. Some work-from-home flexibility may apply as part of a hybrid schedule.

Qualifications

• Certified Pharmacy Technician (CPhT) certification is required.
• Minimum 2 years of pharmacy experience.
• Proficient in MS Office (Excel, Word, PowerPoint).
• Experience in managed care/PBM setting is preferred.

Responsibilities

• Set up and process PA requests from fax, ePA, phone or email.
• Review cases to ensure regulatory and turnaround requirements are met.
• Document case notes for PAs requiring pharmacist or medical director review.
• Run test claims for approved authorizations and contact members/providers.
• Communicate with providers to process phone PAs and resolve inquiries.

Skills

CPhT certification

Pharmacy experience

MS Office proficiency

Education

High School Diploma or GED

Associate's degree in Healthcare or related area

Tools

RxClaims

PAHub

Job description

Point32Health is hiring a Pharmacy Utilization Management (UM) Specialist to set up and process drug prior authorization requests. You will review cases for regulatory compliance, document notes, and run test claims while coordinating with providers and members.

The role requires a CPhT certification, 2+ years of pharmacy experience, and strong MS Office skills. Some work-from-home flexibility may apply as part of a hybrid schedule.