Remote Utilization Management Pharmacist - Prior Auth

Judi Health, LLC; Northern (KY); Hybrid; USD 125,000 - 130,000; Full time

Job summary

Judi Health, LLC is seeking a Utilization Management Pharmacist to promote safe, effective medication use. This remote role reviews prior authorizations, supports clinical programs, and provides expert guidance to members, providers, and pharmacies in a fast-paced, collaborative setting.

The position requires knowledge of managed care or PBM, strong communication and documentation skills, and flexibility to work after hours, weekends, and holidays as needed.

Qualifications

• Pharmacy degree required (B.Pharm or PharmD).
• At least 6–12 months in prior authorization or utilization management.
• 2+ years of pharmacy practice experience.
• Experience in managed care or PBM networks.
• Strong written and verbal communication skills.
• Ability to handle multiple priorities in high-volume settings.
• Availability for after-hours, weekends, and holidays.

Responsibilities

• Review and decide on prior authorizations and appeals.
• Ensure compliance with federal, state, and internal rules.
• Document clinical decisions per URAC/NCQA standards.
• Provide empathetic support to members, prescribers, and pharmacies.
• Stay current with clinical guidelines and regulatory changes.
• Protect patient privacy per HIPAA; report fraud, waste, abuse.
• Assist leadership with projects and process improvements.

Skills

Prior Authorization

Utilization Management

Pharmacy Practice

Managed Care

Communication

Writing

Organization

Prioritization

After-Hours

Education

Pharmacy degree (B.Pharm or PharmD)

Job description

Judi Health, LLC is seeking a Utilization Management Pharmacist to promote safe, effective medication use. This remote role reviews prior authorizations, supports clinical programs, and provides expert guidance to members, providers, and pharmacies in a fast-paced, collaborative setting.

The position requires knowledge of managed care or PBM, strong communication and documentation skills, and flexibility to work after hours, weekends, and holidays as needed.