Utilization Management Pharmacist (Fully Remote)

Judi Health, LLC; United States; Remoto; USD 120.000 - 150.000; Tempo pieno

Descrizione del lavoro

Judi Health, LLC is seeking an Utilization Management Pharmacist in the United States to oversee prior authorization processes and support clinical programs. The role emphasizes expert guidance to members, providers, and pharmacies while ensuring safe and effective medication use.

The position requires an active pharmacist license and a PharmD or Bachelor of Pharmacy, with 6 months to 1 year of UM or prior authorization experience.

Competenze

• Active, unrestricted pharmacist license.
• Bachelor’s degree or Doctor of Pharmacy.
• Experience with prior authorization or utilization management.
• Strong communication and organizational skills.

Mansioni

• Make timely, evidence-based decisions on prior authorizations, appeals, and override requests.
• Accurately document clinical decisions and maintain records in accordance with regulatory and accreditation standards.
• Identify and report potential fraud, waste, and abuse, and support training of team members as needed.

Conoscenze

Pharmacy licensure

Prior Authorization

Clinical knowledge

Communication

Organization

Formazione

PharmD or Bachelor of Pharmacy

Descrizione del lavoro

• The Utilization Management Pharmacist promotes safe, effective, and appropriate medication use.
• This role reviews prior authorization requests, supports clinical programs, and provides expert guidance to members, providers, and pharmacies.

Responsibilities:

• Make timely, evidence-based decisions on prior authorizations, appeals, and override requests.
• Accurately document clinical decisions and maintain records in accordance with regulatory and accreditation standards.
• Identify and report potential fraud, waste, and abuse, and support training of team members as needed.

Qualifications:

• Active, unrestricted pharmacist license and a Bachelor's or Doctor of Pharmacy degree.
• Minimum of 6 months to a year of prior authorization or utilization management experience.
• Strong communication, organizational skills, and ability to manage multiple priorities in a metric-driven environment.
• Judi Health replaces fragmented systems with a Unified Claims Processing architecture.
• The company delivers true price transparency and AI-powered care delivery to achieve operational efficiency.

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. It is the intelligence platform powering benefits plans for millions of Americans, focused on operational efficiency and service excellence.