Remote Utilization Management Pharmacist - Evidence-Based

U.S. Anesthesia Partners; United States; On-site; USD 95,000 - 150,000; Full time

Job summary

TruDataRx, Inc. is seeking a Utilization Management Clinical Pharmacist to apply data-driven insights and evidence-based guidelines in a fast-paced, virtual environment.

You will adjudicate prior authorizations and appeals, leveraging clinical databases and plan criteria to ensure clinically appropriate, cost-effective medications for members. Ideal candidates hold a PharmD and a state license, with managed care experience and strong communication skills.

Qualifications

• Managed care experience required.
• Strong ability to evaluate and apply complex clinical data to case reviews.
• Able to work independently in a virtual environment.
• Detail-oriented with strict adherence to protocols.
• Excellent written and verbal communication skills.

Responsibilities

• Evaluate and adjudicate PA requests against clinical criteria.
• Evaluate and adjudicate appeal requests for clinical appropriateness and medical necessity.
• Apply plan criteria and evidence-based guidelines to timely determinations.
• Review drug data, indications, and clinical parameters during adjudication.
• Communicate approvals/denials clearly to providers and members.
• Collaborate with prescribers and outreach to resolve medication concerns.

Skills

Managed Care

Clinical Acumen

Remote Work

Detail Oriented

Communication

Education

PharmD degree

Tools

Medi-Span

First Databank

Job description

TruDataRx, Inc. is seeking a Utilization Management Clinical Pharmacist to apply data-driven insights and evidence-based guidelines in a fast-paced, virtual environment.

You will adjudicate prior authorizations and appeals, leveraging clinical databases and plan criteria to ensure clinically appropriate, cost-effective medications for members. Ideal candidates hold a PharmD and a state license, with managed care experience and strong communication skills.