Remote Pharmacy Utilization & PA Specialist

Point32Health, Inc.; Massachusetts; Remote; USD 34,000 - 50,000; Full time

Job summary

Point32Health, Inc. is seeking a Pharmacy Utilization Management (UM) Specialist to set up and process prior authorization cases. You will manage PA requests from multiple channels and ensure timely reviews by pharmacists or medical directors. A strong background in pharmacy and PBM operations is essential.

The role supports remote work and requires attention to detail, compliance with regulations, and collaboration with providers and care teams to maintain high-quality patient care.

Qualifications

• High School Diploma or GED required; associate degree preferred.
• Minimum 2 years of pharmacy experience.
• Experience with managed care/PBM is a plus.

Responsibilities

• Set up PA requests from fax, ePA, phone and email.
• Review cases for regulatory requirements and turnaround times.
• Document case notes for PAs requiring pharmacist or medical director review.
• Run test claims for approved authorizations and liaise with members/providers.
• Handle provider inquiries and manage the ePA queue.
• Support quality checks and implement process improvements.

Skills

Pharmacy experience

MS Office

Attention to detail

Time management

Team collaboration

Education

High School Diploma or GED

Associate's degree in Healthcare or related area

Tools

RxClaims

PAHub

Microsoft Office

Job description

Point32Health, Inc. is seeking a Pharmacy Utilization Management (UM) Specialist to set up and process prior authorization cases. You will manage PA requests from multiple channels and ensure timely reviews by pharmacists or medical directors. A strong background in pharmacy and PBM operations is essential.

The role supports remote work and requires attention to detail, compliance with regulations, and collaboration with providers and care teams to maintain high-quality patient care.