Pharmacist - Utilization Management (UM) - Remote

Job Summary This job reviews requests for medication coverage determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by the physician against medical policy criteria. The incumbent then uses his/her clinical knowledge compared to the policy and physician request to make a determination. At times, the incumbent may conduct additional research beyond medical policy review to make coverage determinations. Essential Responsibilities Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure claims are properly routed and paid. Conduct research beyond medical policy review to make decisions on medication coverage requests. Other duties as assigned. Education Required Bachelor's degree in Pharmacy Preferred Doctorate degree in Pharmacy Substitutions None Experience Required 1 - 3 years in Pharmacy Preferred None Licenses or Certifications Required Registered Pharmacist Preferred None Skills Oral & Written Communication Skills General Computer Skills Problem Solving & Decision Making Compliance Prioritizing Language Requirement (other than English) None Travel Required None Physical, Mental Demands and Working Conditions Position Type: Office-Based Teaches / trains others regularly: Occasionally Travel regularly from the office to various work sites or from site-to-site: Rarely Works primarily out-of-the office selling products/services (sales employees): Never Physical work site required: Yes Lifting: up to 10 pounds: Constantly Lifting: 10 to 25 pounds: Rarely Lifting: 25 to 50 pounds: Rarely Pay Range Minimum: $67,500.00 Pay Range Maximum: $126,000.00 EEO Statement Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. #J-18808-Ljbffr

Created: 2026-04-20