Remote Utilization Management Clinical Pharmacist

CommunityCare, Inc.; Tulsa, Northern (OK, KY); Hybrid; USD 110,000 - 140,000; Full time

Benefits offered by this job

Remote work eligibility

Job summary

CommunityCare, Inc. seeks an Utilization Management Clinical Pharmacist to optimize medication use, support formulary development, and ensure evidence-based, cost-conscious therapy for members.

You will review prior authorization requests for medical injectable and specialty meds, collaborate with clinicians, and develop clinical criteria to support UM programs. Remote work option may be available for qualified candidates.

Qualifications

• Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy from an accredited School of Pharmacy.
• Current, unrestricted pharmacist license in the State of Oklahoma, or ability to obtain Oklahoma licensure within 180 days of hire.
• Minimum of five years of clinical pharmacy experience in managed care/pharmacy benefit management or related setting.
• Experience reviewing prior authorization requests for medical injectable and specialty medications with Medicare Part D and Commercial lines of business preferred.

Responsibilities

• Review prior authorization requests for medical injectable and specialty medications using evidence-based criteria and regulations.
• Approve or deny medication requests within established turnaround times.
• Collaborate with technicians, medical directors, and clinicians to support UM decisions.
• Provide clinical consultation on complex medication requests and coverage determinations.
• Develop and maintain clinical criteria, policies, and PA guidelines.

Skills

Managed care pharmacy

Utilization management

Formulary management

Regulatory requirements

Analytical skills

Communication skills

Education

PharmD or BS Pharmacy

Oklahoma pharmacy license or eligibility

Tools

Pharmacy information systems

Microsoft Office

Job description

CommunityCare, Inc. seeks an Utilization Management Clinical Pharmacist to optimize medication use, support formulary development, and ensure evidence-based, cost-conscious therapy for members.

You will review prior authorization requests for medical injectable and specialty meds, collaborate with clinicians, and develop clinical criteria to support UM programs. Remote work option may be available for qualified candidates.