Utilization Management Pharmacist (temp-to-hire)

Transformcap; Jersey City (NJ); On-site; USD 112,500 - 137,500; Full time

Job summary

Transformcap is looking for a Clinical Care Pharmacist in Jersey City, New Jersey, responsible for promoting safe and effective medication use. You will review prior authorization requests, support clinical programs, and provide guidance to members, prescribers, and pharmacies in a collaborative environment.

The ideal candidate holds an active pharmacist license and has strong communication and organizational skills with experience in pharmacy services. The position offers a salary range of $125,000 annually and requires flexibility to work after hours and weekends.

Qualifications

• 6 months to a year of prior authorization experience required.
• Active, unrestricted pharmacist license necessary.
• Minimum of 2 years pharmacy practice experience expected.

Responsibilities

• Review and make decisions on prior authorizations and appeals.
• Ensure compliance with regulations across various plans.
• Document clinical decisions in accordance with standards.
• Provide support to members and pharmacies via phone.

Skills

Prior authorization experience

Communication skills

Organizational skills

Ability to manage multiple priorities

Education

Bachelor’s or Doctor of Pharmacy degree

Job description

About Judi Health

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including:

• Capital Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,
• Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and
• Judi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform.

Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.judi.health.

Position Summary

The Clinical Care Pharmacist plays a vital role in promoting safe, effective, and appropriate medication use. This position is responsible for reviewing prior authorization requests, supporting clinical programs, and providing expert guidance to members, providers, and pharmacies. The role combines clinical decision-making with a strong focus on service excellence in a fast-paced, collaborative environment.

Position Responsibilities

• Review and make timely, evidence-based decisions on prior authorizations, appeals, and override requests using clinical guidelines and benefit criteria.
• Ensure compliance with federal, state, and internal regulations across Commercial, Exchange, Medicare, and Medicaid plans.
• Accurately document clinical decisions and maintain thorough records in accordance with regulatory and accreditation (URAC/NCQA) utilization review standards.
• Provide clear, empathetic support to members, prescribers, and pharmacies by responding to clinical inquiries via phone, demonstrating professionalism, active listening, and a patient-centered approach.
• Stay current with clinical prescribing guidelines, internal policies, and regulatory changes, and apply them to daily responsibilities.
• Follow all internal procedures, job aids, and HIPAA guidelines to protect patient privacy and data security.
• Identify and report potential fraud, waste, and abuse.
• Support training and development of new and existing team members as needed.
• Assist leadership with special projects, process improvements, and operational initiatives.

Minimum Qualifications

• Minimum of 6 months to a year of prior authorization experience
• Active, unrestricted, pharmacist license
• Bachelor’s or Doctor of Pharmacy degree
• Minimum of 2 years of pharmacy practice experience
• Experience in managed care or pharmacy benefit management (PBM)
• Strong communication, writing, and organizational skills
• Ability to manage multiple priorities in a high-volume, metric-driven environment
• Availability to work after hours, weekends, and holidays on a rotating schedule

Preferred Qualifications

• Call center experience

This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

Salary Range: $125,000 – $125,000 USD

All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.