Clinical Pharmacist, Utilization Management

Rightway • Dallas, TX

4d • $120,000 - $125,000

About The Position

ABOUT THE ROLE: Our PBM goal is to help clients better manage pharmacy spend to make drugs more affordable for their employees and dependents. Rightway is responsible for designing, building, and operating a new-to-the-world PBM model based on our core tenets: fairness & transparency, unlocking the supply chain, supporting the physician-patient relationship, and utilizing navigation to empower consumers. This role will assist UM leadership in delivering on our UM strategy and actively work UM cases. The Clinical Pharmacist, Utilization Management is a member of the Rightway PBM Clinical Operations team. Our pharmacy benefit management (PBM) offering represents an important growth area for Rightway. Helping clients better manage pharmacy spend to make drugs more affordable for their employees and dependents is critical to their business sustainability. RightwayRx is responsible for designing, building and operating a new-to-the-world PBM model base on our core tenets: fairness & transparency, unlocking the supply chain, supporting the physician-patient relationship, and utilizing navigation to empower consumers

Requirements

• Pharmacy Degree Required, PharmD preferred.
• 1 year experience coordinating medication selection with prescribers and their care teams.
• Pharmacist license in good standing in state of residence. Willingness to achieve and maintain licensure in multiple states (if needed)
• Available to work 40 hours/week. Core operating hours are weekdays within 8 am Eastern Time and 8 pm Eastern Time, but may be required to work evening and/or weekend shifts in the future as Rightway grows. On call approximately once every two months.
• Detail-oriented, intellectually and clinically curious, good listener, empathetic, ability to challenge status quo, values exemplar
• Great pharmacy benefit knowledge, effective & creative problem-solver, ability to prioritize and manage through change.
• Solid communication skills, ability to lead projects and influence others even without direct reporting line ownership

Nice To Haves

• 1-3+ years of managed care (PBM or health plan) prior authorization experience

Responsibilities

• Support all lines of business via reviewing utilization management requests for coverage that are clinically appropriate and cost effective
• Continual review of UM operational processes to ensure effective and compliant delivery of PBM services to our clients.
• Coordinate with Pharmacy technicians, Pharmacists, and/or Medical Directors on UM activities
• Ensure cases are reviewed in accordance with State and/or Federal guidelines including turnaround time requirements
• As needed, discuss clinical strategy and decision rationale with prescribers
• Participate in the quality review and inter-rater reliability processes
• Supports P&T process including the development of therapeutic class/drug monographs as needed
• Research and develop therapy-specific clinical policies and utilization management programs such as Prior Authorization, Step Therapy, Quantity Limit, and/or Coverage Determination programs
• Support Clinical Operations leadership and coordinate with Pharmacy Navigation team as needed

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Ph.D. or professional degree
• Number of Employees: 501-1,000 employees