Utilization management Pharmacist

Not applicable; United States; Remote; USD 55,000 - 83,000; Full time

Job summary

Not provided in the posting. Utilization management pharmacists operate remotely in the United States, earning $40–$60 per hour on a W2 basis. Benefits begin after 30 days of employment, with biweekly payroll and a 9:00–17:30 EST training window.

The role centers on clinical review, denials, and support for UM activities. The candidate must be a licensed pharmacist with a PharmD preferred and a Bachelor’s in Pharmacy.

Qualifications

• Licensed Pharmacist with current license required.
• Bachelor's Degree in Pharmacy required; PharmD preferred.
• Proficient with Microsoft Office applications.
• Utilization Management experience preferred but not required.
• Experience with Specialty Pharmacy/pharmaceuticals preferred.
• 2+ years lead/supervisor or retail pharmacy experience preferred.

Responsibilities

• Review plans policy to determine coverage for medications.
• Provide clinical support and oversight for UM activities.
• Finalize denials of clinical prior authorization requests.

Skills

Clinical knowledge

Decision making

Critical thinking

Team collaboration

Clinical reviews

Pharmacy knowledge

Education

Licensed Pharmacist

Bachelor's Degree in Pharmacy

PharmD preferred

Tools

Microsoft Office

Job description

Pay Rate: $40-$60/hour on W2 without any benefits (The hourly rate is all-inclusive. Health benefits are available after 30 days of employment for W2 employees and are subject to employee contribution. Payroll is processed on a biweekly basis.)

Shift: Training will be 9am-5:30pm EST... their shift will be 9:30-6pm in their time zone starting 1/4/27... 100% remote. Start date is 11/30 but the shift will change after 01/04/2027

Duties:

Utilization management pharmacists are responsible for reviewing each plans policy to determine if coverage can be granted for a medication. Provide clinical support and oversight for all utilization management (UM) activities. Responsible for finalizing all denials of clinical prior authorization requests.

Skills:

• Supports the Coverage Review Department (CRD) as a clinical resource for drug therapy questions
• Applies critical thinking to achieve proper clinical decisions when performing clinical reviews
• Utilizes multiple systems and other clinical resources to achieve proper decisions in Utilization Management reviews
• Works and maneuvers within a queue system that prioritizes clinical reviews
• Makes clinical decisions quickly and at times decides and acts with limited information
• Works and collaborates with a multi-disciplinary clinical team to provide a customer centric experience

3 Non-Negotiable Skills:

• Strong clinical knowledge
• Able to make decision

Education:

• Licensed Pharmacist required
• Bachelor's Degree in Pharmacy required; PharmD preferred
• Proficient technical skills utilizing Microsoft Office applications required
• Utilization Management Experience Preferred, but not required
• Experience with Specialty Pharmacy/Pharmaceuticals preferred
• 2+ years lead/supervisor or retail pharmacy experience preferred