Clinical Utilization Management Pharmacist - Remote

Overview

The Clinical Utilization Management Pharmacist is responsible for performing drug utilization reviews for various clients and collaborating with the pharmacy team to ensure compliance with regulatory standards.

In Short

• Perform drug utilization reviews for ASO clients and Medicare Advantage plans.
• Collaborate with the pharmacy team and Medical Directors.
• Ensure compliance with accreditation and regulatory standards.
• Identify and address utilization review trends.
• Participate in the appeals process for drug reviews.
• Serve as a subject matter expert in utilization management.
• Assist with internal policy needs related to drug reviews.
• Conduct monthly analysis of claims data.
• Provide training and support for pharmacy residents and students.
• Work in a standard office environment with potential travel.

Requirements

• Current and unrestricted pharmacy license in the state of residence.
• Three years of experience as a pharmacist in a clinical setting.
• Two years of managed care experience.
• Knowledge of CMS regulations and HIPAA.
• Strong communication and teamwork skills.
• Ability to work under stressful conditions.
• Extensive knowledge of Microsoft Office applications.

Benefits

• Opportunity to work in a collaborative team environment.
• Engagement in meaningful work with ASO clients and Medicare plans.
• Access to training and development opportunities.
• Support for professional growth and advancement.