Remote Utilization Management Clinical Pharmacist

CommunityCare, Inc.; Tulsa (OK); Remote; USD 120,000 - 150,000; Full time

Job summary

CommunityCare, Inc. is seeking an Utilization Management Clinical Pharmacist to optimize medication use, support formulary development, and ensure compliance across medical injectable and specialty therapies.

The role emphasizes evidence-based care, cost-conscious decisions, and collaboration with clinicians to improve member outcomes. The position requires PharmD or BS in Pharmacy, an active US license, and at least five years in managed care or PBM settings, with experience in prior

Qualifications

• Requires strong knowledge of managed care pharmacy, utilization management and formulary management.
• Understanding of Medicare, Commercial and PBM operations.
• Ability to interpret clinical literature, guidelines, and regulations.
• Strong analytical, organizational, and decision-making skills.
• Excellent written, verbal, and presentation abilities.
• Ability to collaborate across multidisciplinary teams.
• Proficiency with Microsoft Office and pharmacy IT systems.
• Remote work eligibility for qualified candidates.
• On-call coverage on weekends/holidays on a rotating schedule.
• Successful completion of Health Care Sanctions background check.

Responsibilities

• Review prior authorization requests for medical injectable and specialty meds using evidence-based criteria.
• Approve or deny requests within established turnaround times.
• Collaborate with technicians, medical directors, and clinicians to support UM decisions.
• Provide clinical consultation on complex requests and coverage determinations.
• Support development and maintenance of medical drug utilization management programs.
• Develop clinical criteria, policies and prior authorization guidelines.
• Perform annual policy reviews updating criteria with new evidence and guidelines.
• Monitor new drug approvals and suggest UM strategies.
• Create educational materials for providers and internal stakeholders.
• Participate in provider outreach and detailing on evidence-based prescribing and formulary optimization.
• Support newsletters and clinical training initiatives.
• Perform other related duties as required.

Skills

Managed care pharmacy

Utilization management

Formulary management

Clinical decision making

Medicare PBM knowledge

Communication skills

Microsoft Office

Pharmacy information systems

On-call coverage

Education

PharmD or BS in Pharmacy

Active pharmacist license in US

5+ years clinical pharmacy experience

Experience reviewing prior authorization for medical injectable and specialty meds (Medicare Part D/Commercial)

Job description

CommunityCare, Inc. is seeking an Utilization Management Clinical Pharmacist to optimize medication use, support formulary development, and ensure compliance across medical injectable and specialty therapies.

The role emphasizes evidence-based care, cost-conscious decisions, and collaboration with clinicians to improve member outcomes. The position requires PharmD or BS in Pharmacy, an active US license, and at least five years in managed care or PBM settings, with experience in prior