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Utilization Management Pharmacist (Temp, Temp-to-hire)

3 months, 1 week ago
United States
Contract
Junior
Customer Support
Customer and Technical Support
HIPAA
Apply Now
Capital Rx

Capital Rx

Capital Rx provides comprehensive health benefit management and transparent pharmacy benefit management solutions, integrating various healthcare services to support millions of plan members across diverse sectors.

Health Care Providers & Services
251-1K
Founded 2017
View All Jobs 3

Description

  • Review prior authorization, appeal, and override requests and make timely, evidence-based clinical decisions using guidelines and benefit criteria.
  • Ensure compliance with federal, state, and internal regulations across Commercial, Exchange, Medicare, and Medicaid plans.
  • Document clinical decisions accurately and maintain thorough records in line with URAC/NCQA utilization review standards.
  • Provide empathetic clinical support to members, prescribers, and pharmacies by phone.
  • Stay current on prescribing guidelines, internal policies, and regulatory changes and apply them in daily work.
  • Follow internal procedures, job aids, HIPAA requirements, and data security practices.
  • Identify and report potential fraud, waste, and abuse.
  • Support training and development of team members as needed.
  • Assist leadership with special projects, process improvements, and operational initiatives.

Requirements

  • 6 months to 1 year of prior authorization experience.
  • Active, unrestricted pharmacist license.
  • Bachelor’s degree or Doctor of Pharmacy degree.
  • At least 2 years of pharmacy practice experience.
  • Experience in managed care or pharmacy benefit management (PBM).
  • Strong communication, writing, and organizational skills.
  • Ability to manage multiple priorities in a high-volume, metric-driven environment.
  • Availability to work after hours, weekends, and holidays on a rotating schedule.
  • Call center experience is preferred.

Benefits

  • Salary range of $125,000.
  • Flexible position responsibilities that may be reassigned as needed to support organizational goals.
  • Equal employment opportunity and a workplace committed to diversity and inclusion.
  • Privacy practices for applicant data are disclosed and governed by Judi Health’s privacy policy.

Interested in this position?

Apply directly on the company website

Apply Now

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