Clinical Pharmacy - Utilization Management Clinical Pharmacist 146-2005
About The Position
The Utilization Management Clinical Pharmacist optimizes medication use and member outcomes while ensuring regulatory compliance. The role provides clinical expertise in medical injectable and specialty medication utilization management, formulary development, clinical policy creation, and other clinical pharmacy initiatives. It supports safe, effective, evidence-based, and cost-conscious drug therapy while advancing organizational quality, compliance, and operational goals. The pharmacist reviews medication authorization requests, provides clinical consultation, and helps develop and maintain utilization management programs, clinical criteria, treatment policies, and prior authorization guidelines. The position also supports medication therapy management, pharmacy case management, provider education, and related clinical initiatives. Qualified candidates may work remotely. Weekend and holiday on-call coverage is required on a scheduled rotation.
Requirements
- Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy from an accredited School of Pharmacy.
- Current, unrestricted pharmacist license in the State of Oklahoma, or ability to obtain Oklahoma licensure within 180 days of hire.
- 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 collaborate effectively across multidisciplinary teams.
- Proficiency with Microsoft Office applications and pharmacy information systems.
- Successful completion of a Health Care Sanctions background check.
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.
- Support the Medication Therapy Management Program by conducting Comprehensive Medication Reviews (CMRs) and other activities as needed to support program and quality initiatives.
- Perform pharmacy case management to identify medication-related problems and recommend evidence-based interventions to optimize therapy for identified members.
- 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.
- Provide on-call coverage for weekends and holidays on a scheduled rotation.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
