Remote Utilization Management Pharmacist – Data-Driven Care

TruDataRx; United States; On-site; USD 90,000 - 120,000; Full time

Job summary

TruDataRx, Inc. seeks an experienced Utilization Management Clinical Pharmacist to join a virtual team of physicians, pharmacists and scientists. You will apply data-driven insights and evidence-based guidelines to coverage determinations, ensuring clinically appropriate, cost-effective medications for members.

The role emphasizes adherence to quality, regulatory, and turnaround standards in a fast-paced, remote setting. Strong managed care experience and pharmacotherapy expertise are essential.

Qualifications

• Doctor of Pharmacy (PharmD) degree from an accredited institution.
• Active, unrestricted pharmacist license in your state of residence.
• Prior managed care, utilization management, or pharmacy benefit management (PBM) operations experience.
• Strong clinical skills with ability to evaluate and apply complex clinical data to case reviews.
• Excellent written and verbal communication with a customer-service mindset.

Responsibilities

• Evaluate and adjudicate prior authorization (PA) requests against established clinical criteria.
• Evaluate and adjudicate appeal requests for clinical appropriateness and medical necessity.
• Apply plan criteria, evidence-based guidelines, and regulatory standards to deliver timely determinations in a fast-paced environment.
• Leverage clinical drug databases to review drug data, indications, and clinical parameters during adjudication.
• Communicate approval and denial decisions clearly to providers and members.
• Collaborate with prescribers and outreach to members to resolve medication concerns.
• Support process improvement initiatives to streamline workflows and turnaround times.
• Maintain up-to-date knowledge of managed care trends, comparative effectiveness research, and clinical guidelines.

Skills

Managed Care Experience

Clinical Acumen

Remote Productivity

Process-Oriented

Communication Excellence

Education

PharmD degree

Active pharmacist license

Tools

Medi-Span

First Databank

Job description

TruDataRx, Inc. seeks an experienced Utilization Management Clinical Pharmacist to join a virtual team of physicians, pharmacists and scientists. You will apply data-driven insights and evidence-based guidelines to coverage determinations, ensuring clinically appropriate, cost-effective medications for members.

The role emphasizes adherence to quality, regulatory, and turnaround standards in a fast-paced, remote setting. Strong managed care experience and pharmacotherapy expertise are essential.