Utah Medicaid Pharmacist DHHS

Utah Division of Human Resource Management; Salt Lake City (UT); Hybrid; USD 59,000 - 89,000; Full time

Benefits offered by this job

Full benefits package

Hybrid work arrangement

In-office Monday/Tuesday presence

Job summary

Utah Medicaid Pharmacist DHHS is a full-time/hybrid role focused on developing and overseeing pharmacy coverage policies and prior authorization criteria. The pharmacist will review clinical information, analyze claims, and stay current with Medicaid pharmacy program requirements to ensure safe, effective medications for members.

The position requires Utah licensure, strong communication, and data interpretation skills, with a hybrid in-office/remote schedule and a competitive benefits package.

Qualifications

• Must reside in Utah and be available to work in-office on Mondays and Tuesdays; hybrid schedule subject to change.
• Must hold a current and active pharmacist license in good standing in the State of Utah.
• Knowledge of pharmacotherapy, clinical pharmacy practice, and evidence-based treatment guidelines; experience evaluating literature and drug information.
• Ability to review clinical information and apply established criteria to determine medical necessity and medication coverage.
• Strong written and verbal communication skills; organize and document clinical information for accurate records.

Responsibilities

• Develop, implement, and maintain pharmacy coverage policies and clinical prior authorization criteria.
• Review and evaluate prior authorization requests for clinical appropriateness and necessity.
• Perform comprehensive clinical reviews by evaluating patient information against policy criteria and guidelines.
• Evaluate and interpret literature and guidelines to support policy decisions.
• Analyze pharmacy and medical claims data to identify trends and opportunities for program improvement.
• Collaborate with internal teams and participate in workgroups to support program initiatives.

Skills

Pharmacotherapy

Clinical pharmacy

Evidence-based guidelines

Communication skills

Data analysis

Education

Utah Pharmacist License

Tools

PDL knowledge

DUR processes

Job description

Utah Medicaid Pharmacist DHHS

FT / PT Status - Full-Time

Benefits Eligibility - This position is eligible for a full benefits package.

Salary - $42.78 - $64.25 Hourly Wage

Remote Work / In-Office - Hybrid

Application Deadline - 10/25/2026

Key Responsibilities

Utah Medicaid Pharmacist to support the development, implementation, and oversight of pharmacy coverage policy and prior authorization programs. This position is responsible for reviewing and developing coverage policies, creating and maintaining clinical prior authorization criteria, evaluating prior authorization requests to ensure alignment with clinical guidelines and program requirements, and participating in clinical programs and related processes to help ensure Medicaid members have access to safe, effective, and appropriate medications.

Key responsibilities and day to day responsibilities of this position:

• Develop, implement, and maintain pharmacy coverage policies and clinical prior authorization criteria.
• Review and evaluate prior authorization requests for clinical appropriateness, and necessity.
• Perform comprehensive clinical reviews by evaluating patient information against established policy criteria, clinical guidelines, and evidence-based recommendations.
• Evaluate and interpret clinical literature, treatment guidelines, and emerging evidence to support policy and coverage decisions.
• Analyze pharmacy and medical claims data to identify trends and opportunities to improve the Medicaid pharmacy program.
• Participate in clinical programs such as Drug Utilization Review (DUR), provider outreach, and peer-to-peer education.
• Communicate prior authorization determinations clearly and professionally to providers and members.
• Collaborate with internal teams and contribute to workgroups to support program initiatives and process improvements.
• Maintain accurate documentation of reviews, decisions, and supporting information to ensure a complete and compliant audit trail.
• Contribute to process improvement efforts by identifying opportunities to streamline workflows and enhance program effectiveness.
• Support assigned projects and initiatives within established timelines.
• Remain current on clinical information, drug therapies, and Medicaid pharmacy program requirements.
• Triage incoming phone calls from providers specific to prior authorization decisions.
• Perform other related duties as assigned.

Supplemental Information

• Licensure to practice pharmacy in the state of Utah. 58-17b-303 License required - Licensure classifications for individuals. (1) A license is required to engage in the practice of pharmacy
• An offer of employment will be contingent on the applicant successfully passing a DHHS background check.
• This position is currently a hybrid of two (2) days in-office and three (3) remote work days. Please note, a position's eligibility for remote work is established by agency management and is subject to change at their discretion, at any time, and for any reason.
• Effective July 1, 2021, State of Utah Employees must either reside in Utah or be in the process of relocating to Utah within 30 days of their start date.
• Risks which require the use of special safety precautions and/or equipment, e.g., working around operating machines, working with contagious diseases or hazardous chemicals, etc.
• Typically, the employee may sit comfortably to perform the work; however, there may be some walking; standing; bending; carrying light items; driving an automobile, etc. Special physical demands are not required to perform the work.

Qualifications

• Must reside in Utah and be available to work in-office on Mondays and Tuesdays. (Of note, hybrid work schedule is subject to change.)
• Must hold a current and active pharmacist license in good standing in the State of Utah.
• Knowledge of pharmacotherapy, clinical pharmacy practice, and evidence-based treatment guidelines.Experience evaluating clinical literature, treatment guidelines, and drug information.
• Ability to review clinical information and apply established criteria to determine medical necessity and medication coverage.
• Strong written and verbal communication skills, including clearly communicating clinical determinations to providers and stakeholders.
• Ability to organize and document clinical information to maintain accurate and compliant records.
• Experience working in a team environment and managing multiple priorities in a fast-paced setting.
• Preference may be given to those that have:
• Experience working with Medicaid pharmacy programs or other public health programs.
• Experience developing or maintaining pharmacy coverage policies or clinical prior authorization criteria.
• Experience reviewing prior authorization requests or performing clinical case reviews.
• Knowledge of Drug Utilization Review (DUR) processes and provider outreach programs.
• Experience analyzing pharmacy or medical claims data to identify trends or opportunities for program improvement.
• Familiarity with Preferred Drug Lists (PDL) and pharmacy benefit management processes.

Location

288 North 1460 West

Salt Lake City, Utah, 84116

United States

Background Check Required - You must successfully pass a criminal history check.

Drug Test Required - No

Schedule Code - B - Competitive Career Service

Why You Should Join Our Team

In Utah, we believe hard work is important, but balance is essential. Finding work/life balance is a vital element to our culture. To find out more about WHY Utah. Other benefits may include:

• Job Stability: Enjoy the security and reliability of employment within a well-established organization.
• Career Growth: Develop valuable skills and gain opportunities for leadership within a large organization.
• Meaningful Work: Contribute to an important service that benefits the community and supports organizational goals.
• Supportive Work Environment: Be part of a team that values cooperation, strong work ethics, and mutual support.

The Agency

For more information on the Division of Integrated Healthcare, please visit our website.

EEO Statement

The State of Utah is committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. We also consider qualified applicants regardless of criminal histories, consistent with legal requirements. For accommodations, please contact [phone].