Clinical Pharmacy - Utilization Management Clinical Pharmacist PC#146-2002

Community Care • Tulsa, OK

2d

About The Position

The Utilization Management Clinical Pharmacist optimizes medication use, improves member outcomes, and supports regulatory compliance. The position provides clinical expertise for medical injectable and specialty medication utilization management, formulary development, clinical policy creation, and other clinical pharmacy initiatives. The role helps ensure members receive safe, effective, evidence-based, and cost-conscious drug therapy while supporting organizational quality, compliance, and operational goals.

The pharmacist reviews and adjudicates prior authorization requests, collaborates with pharmacy technicians, medical directors, and other clinicians, and provides clinical consultation on complex requests and coverage determinations. The position also supports medical drug utilization management programs, develops and maintains evidence-based criteria and policies, reviews policies annually, monitors new drug approvals, and contributes to provider education and outreach. Remote work may be provided to qualified candidates. Scheduled rotating on-call coverage for weekends and holidays is necessary.

Requirements

• Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy from an accredited School of Pharmacy.
• Active, unrestricted pharmacist license in any United States jurisdiction.
• A minimum of five years of clinical pharmacy experience in managed care pharmacy, health plan pharmacy, pharmacy benefit management, specialty pharmacy, hospital pharmacy, or a related clinical practice setting.
• Strong knowledge of managed care pharmacy, utilization management, and formulary management principles.
• Demonstrated understanding of Medicare, Commercial, and pharmacy benefit management operations.
• Ability to interpret and apply clinical literature, treatment guidelines, and regulatory requirements.
• Strong analytical, organizational, critical thinking, and decision-making skills.
• Excellent written, verbal, and presentation skills.
• Ability to effectively collaborate across multidisciplinary teams.
• Proficiency with Microsoft Office applications and pharmacy information systems.
• Successful completion of a Health Care Sanctions background check.
• Availability for scheduled rotating on-call coverage on weekends and holidays.

Nice To Haves

• Prior experience reviewing prior authorization requests for medical injectable and specialty medications with Medicare Part D and Commercial lines of business.

Responsibilities

• Review prior authorization requests for medical injectable, specialty, and other high-cost medications using evidence-based clinical criteria, regulatory requirements, and benefit design.
• Approve or deny medication requests within established turnaround times while ensuring consistency and clinical appropriateness.
• Collaborate with pharmacy technicians, medical directors, and other clinicians to facilitate timely and accurate utilization management decisions.
• Provide clinical consultation regarding complex medication requests and coverage determinations.
• Support the development, implementation, and maintenance of medical drug utilization management programs.
• Develop and maintain evidence-based clinical criteria, treatment policies, and prior authorization guidelines.
• Perform annual policy reviews and update clinical criteria based on emerging evidence, clinical guidelines, and regulatory changes.
• Monitor new drug approvals and recommend appropriate utilization management strategies.
• Develop educational materials and clinical communications for providers and internal stakeholders.
• Participate in provider outreach and academic detailing initiatives focused on evidence-based prescribing and formulary optimization.
• Support provider newsletters, educational programs, and clinical training initiatives.
• Perform other related job duties as required or assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level