Utilization Management Pharmacist – Temp, Temp-to-hire

Capital Rx

Utilization Management Pharmacist managing prior authorization reviews and providing clinical guidance at Judi Health. Ensuring compliance with regulatory standards in a fast-paced environment.

Posted 5/12/2026full-timeRemote • 🇺🇸 United StatesJunior💰 $125,000 per yearWebsite

About the role

Key responsibilities & impact

Review and make timely, evidence-based decisions on prior authorizations, appeals, and override requests using clinical guidelines and benefit criteria.
Ensure compliance with federal, state, and internal regulations across Commercial, Exchange, Medicare, and Medicaid plans.
Accurately document clinical decisions and maintain thorough records in accordance with regulatory and accreditation (URAC/NCQA) utilization review standards.
Provide clear, empathetic support to members, prescribers, and pharmacies by responding to clinical inquiries via phone, demonstrating professionalism, active listening, and a patient-centered approach.
Stay current with clinical prescribing guidelines, internal policies, and regulatory changes, and apply them to daily responsibilities.
Follow all internal procedures, job aids, and HIPAA guidelines to protect patient privacy and data security.
Identify and report potential fraud, waste, and abuse.
Support training and development of new and existing team members as needed.
Assist leadership with special projects, process improvements, and operational initiatives

Requirements

What you’ll need

Minimum of 6 months to a year of prior authorization experience
Active, unrestricted, pharmacist license
Bachelor’s or Doctor of Pharmacy degree
Minimum of 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

Benefits

Comp & perks

🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account Capital Rx Website LinkedIn All Job Openings 501 - 1000 employees Founded 2017 ⚕️ Healthcare Insurance 💳 Fintech 🤖 Artificial Intelligence Healthcare Insurance
Fintech
Artificial Intelligence Capital Rx is the fastest growing healthtech company in America, dedicated to transforming the prescription pricing and patient care landscape. Founded in 2017, it offers innovative pharmacy benefit management (PBM) services, including customizable pharmacy benefits for large employers and an AI-powered care navigation platform. Capital Rx focuses on delivering cost-effective solutions and operational efficiencies to clients while ensuring transparency and quality care for patients. Utilization Management Pharmacist – Temp, Temp-to-hire 🔥 22 minutes ago 🇺🇸 United States – Remote 💵 $125k / year ⏰ Full Time 🟢 Junior 💊 Pharmacist Apply Now Find Hiring Managers Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
Review and make timely, evidence-based decisions on prior authorizations, appeals, and override requests using clinical guidelines and benefit criteria.
Ensure compliance with federal, state, and internal regulations across Commercial, Exchange, Medicare, and Medicaid plans.
Accurately document clinical decisions and maintain thorough records in accordance with regulatory and accreditation (URAC/NCQA) utilization review standards.
Provide clear, empathetic support to members, prescribers, and pharmacies by responding to clinical inquiries via phone, demonstrating professionalism, active listening, and a patient-centered approach.
Stay current with clinical prescribing guidelines, internal policies, and regulatory changes, and apply them to daily responsibilities.
Follow all internal procedures, job aids, and HIPAA guidelines to protect patient privacy and data security.
Identify and report potential fraud, waste, and abuse.
Support training and development of new and existing team members as needed.
Assist leadership with special projects, process improvements, and operational initiatives 🎯 Requirements
Minimum of 6 months to a year of prior authorization experience
Active, unrestricted, pharmacist license
Bachelor’s or Doctor of Pharmacy degree
Minimum of 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 Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Pharmacy Experience Associate 🔥 1 hour ago Paratek Pharmaceuticals 51 - 200 🧬 Biotechnology 💊 Pharmaceuticals ⚕️ Healthcare Insurance Website LinkedIn All Job Openings Pharmacy Experience Associate supporting patient access and affordability challenges at Paratek Pharmaceuticals. Collaborating with Healthcare Professionals and pharmacies to resolve prescription fulfillment issues. 🇺🇸 United States – Remote ⏰ Full Time 🟢 Junior 🟡 Mid-level 💊 Pharmacist Pharmacy Experience Associate 🔥 1 hour ago Paratek Pharmaceuticals 51 - 200 🧬 Biotechnology 💊 Pharmaceuticals ⚕️ Healthcare Insurance Website LinkedIn All Job Openings Pharmacy Experience Associate managing patient prescription fulfillment issues for Paratek Pharmaceuticals. Collaborating with pharmacies and healthcare professionals to ensure timely submissions. 🇺🇸 United States – Remote ⏰ Full Time 🟢 Junior 🟡 Mid-level 💊 Pharmacist Prior Authorization Technician – Pharmacy Technician 🔥 2 hours ago Shields Health Solutions 501 - 1000 ⚕️ Healthcare Insurance 💊 Pharmaceuticals ☁️ SaaS Website LinkedIn All Job Openings Prior Authorization Technician providing patient support through medication access and insurance coordination at Shields Health Solutions. Navigating pharmacy systems and assisting patients directly over the phone. 🇺🇸 United States – Remote ⏰ Full Time 🟢 Junior 💊 Pharmacist 🚫👨‍🎓 No degree required Specialty Pharmacy Technician 🔥 2 hours ago Shields Health Solutions 501 - 1000 ⚕️ Healthcare Insurance 💊 Pharmaceuticals ☁️ SaaS Website LinkedIn All Job Openings Specialty Pharmacy Technician providing off-site support and medication management for patients at Shields Health Solutions. Engaging with patients, pharmacists, and insurers effectively. 🇺🇸 United States – Remote 💵 $55k - $70k / year ⏰ Full Time 🟢 Junior 🟡 Mid-level 💊 Pharmacist 🚫👨‍🎓 No degree required Pharmacy Refill Technician 🔥 2 hours ago Shields Health Solutions 501 - 1000 ⚕️ Healthcare Insurance 💊 Pharmaceuticals ☁️ SaaS Website LinkedIn All Job Openings Pharmacy Refill Technician at Shields Health Solutions handling medication refills and patient interactions. Collaborating with pharmacy staff and ensuring accurate workflows in a remote setting. 🇺🇸 United States – Remote 💵 $18 - $22 / hour ⏰ Full Time 🟢 Junior 💊 Pharmacist 🚫👨‍🎓 No degree required View More Pharmacist Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Privacy policy Terms of service Job board SEO course AI Apply Copilot OpenClaw job finder Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs

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Hard Skills & Tools

prior authorizationclinical decision makingdocumentationutilization reviewmanaged carepharmacy benefit managementclinical guidelinesregulatory compliancedata securityfraud detection

Soft Skills

communicationwritingorganizationalactive listeningempathyprofessionalismteam supportprocess improvementmultitaskingpatient-centered approach

Certifications

pharmacist licenseBachelor of PharmacyDoctor of Pharmacy