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Utilization Management Clinical Pharmacist
Career Opportunities InternationalUtilization Management Clinical Pharmacist at TruDataRx ensuring cost-effective, clinically appropriate medications. Collaborating with a team of professionals to support managed care and pharmacy operations.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in evaluating prior authorization requests and applying clinical criteria, while effectively communicating decisions to providers and members. Possesses strong clinical skills and a Doctor of Pharmacy (PharmD) degree, with a focus on process improvement and operational efficiency in managed care settings.
Highest-signal resume keywords
Doctor Of Pharmacy (PharmD)Active Pharmacist LicensePrior Authorization EvaluationClinical Data EvaluationManaged Care Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical Criteria ApplicationEvidence-Based GuidelinesDrug Database ReviewUtilization ManagementPharmacy Benefit Management
Soft Skills
Exceptional Communication SkillsCustomer-Service MindsetSelf-MotivatedHighly OrganizedDetail-Oriented
Industry Keywords
Prior AuthorizationClinical AppropriatenessMedical NecessityOperational WorkflowsCompassionate Care
About the role
Key responsibilities & impact- Evaluate and adjudicate prior authorization (PA) requests for accuracy and against established clinical criteria
- Evaluate and adjudicate appeal requests for clinical appropriateness and medical necessity
- Apply plan criteria, evidence-based guidelines (including comparative effectiveness data), and regulatory standards to deliver timely determinations in a fast-paced environment
- Leverage clinical drug databases to accurately review drug data, indications, and clinical parameters during the adjudication process
- Communicate approval and denial decisions clearly, professionally, and empathetically to providers and members
- Provide clinical support and guidance to Pharmacy Support Specialists handling complex inquiries from prescribers, pharmacies, and members
- Collaborate with prescribers and outreach to members to resolve medication concerns, balancing compassionate care with operational accountability
- Support process improvement initiatives to streamline operational workflows, boost efficiency, and optimize turnaround times
Requirements
What you’ll need- Doctor of Pharmacy (PharmD) degree from an accredited institution
- Active, unrestricted pharmacist license in your state of residence
- Prior experience in managed care, utilization management, or pharmacy benefit management (PBM) operations
- Strong clinical skills with the ability to critically evaluate and apply complex clinical data to individual case reviews
- Self-motivated, highly organized, and capable of working effectively both independently and collaboratively in a virtual environment
- A meticulous eye for detail with a proven ability to precisely follow and apply established plan criteria and protocols
- Exceptional written and verbal communication skills, with a strong customer-service mindset
Benefits
Comp & perks- Clinically appropriate, cost-effective medications
- Compliance with strict quality, regulatory, and turnaround standards