Utilization Management Pharmacist
HealthCare Support is actively seeking multiple
Utilization Management Pharmacist to fill a couple large start classes coming up for our prestigious healthcare client.
Daily Responsibilities for Utilization Management Pharmacist
- 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.
- Identify and report potential fraud, waste, and abuse.
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Schedule: Monday–Friday, 8-hour shifts scheduled between 7:00 AM–11:00 PM, based on business needs. Candidates must have open availability throughout this timeframe and will work a strict 40-hour workweek.
Required Qualifications for Utilization Management Pharmacist
- Bachelors of Pharmacy, Pharm D preferred
- Clear and active pharmacist license in the state they sit in
- 2+ years of utilization management experience working for another Health Insurance Plan/MCO or PBM experience
Benefits for Utilization Management Pharmacist
- Health Insurance
- Dental Insurance
- Life Insurance
- Employee Assistance Program (EAP)
- Access to Investment Accounts
- Career and educational tools within our Ingenovis ACT (advocacy) Program
Pay Details: $60.00 - $62.50/ Hour
Interested in Being Considered?
If you are interested in applying to this position, please click Apply Now for immediate consideration.
For additional questions, you may contact us at
[email protected]. Please include your phone number, Job Title, and location and our recruiters will reach out.
Healthcare Support Staffing, LLC is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.
