Utilization Management Clinical Pharmacist

Rightway; United States; On-site; USD 120,000 - 125,000; Full time

Benefits offered by this job

Bonus

Equity

Job summary

Rightway is seeking a Clinical Pharmacist, Utilization Management to join the PBM Clinical Operations team. The role focuses on reviewing UM requests, ensuring compliant PBM service delivery, and collaborating with pharmacists, technicians, and medical directors to optimize therapeutic outcomes.

The candidate should have a Pharmacy degree (PharmD preferred), active license, and 1+ year of coordination with prescribers; 1–3+ years PBM or health plan prior authorization is preferred.

Qualifications

• Pharmacist degree and state license in good standing.
• 1 year coordinating medication selection with prescribers; 1–3+ years PBM/health plan prior authorization preferred.

Responsibilities

• Review utilization management requests for coverage that are clinically appropriate and cost effective.
• Review UM processes for compliant PBM service delivery.
• Coordinate with pharmacy technicians, pharmacists, and medical directors on UM activities.
• Ensure cases meet state/federal guidelines including turnaround times.
• Discuss clinical strategy with prescribers when needed.
• Participate in quality and inter-rater reliability processes.
• Support P&T process and development of drug monographs.
• Develop therapy-specific UM policies (Prior Authorization, Step Therapy, etc).
• Support Clinical Operations leadership and Pharmacy Navigation coordination.

Skills

Pharmacy benefit knowledge

Problem solving

Communication skills

Project leadership

Education

PharmD preferred

Pharmacy degree required

Job description

Rightway is seeking a Clinical Pharmacist, Utilization Management to join the PBM Clinical Operations team. The role focuses on reviewing UM requests, ensuring compliant PBM service delivery, and collaborating with pharmacists, technicians, and medical directors to optimize therapeutic outcomes.

The candidate should have a Pharmacy degree (PharmD preferred), active license, and 1+ year of coordination with prescribers; 1–3+ years PBM or health plan prior authorization is preferred.