Clinical Utilization Management Pharmacist

WVU Medicine

Clinical Utilization Management Pharmacist responsible for drug reviews for ASO and Medicare Advantage clients. Engage with pharmacy teams ensuring compliance with accreditation and regulatory standards.

Posted 5/15/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSeniorWebsite

About the role

Key responsibilities & impact

Perform drug utilization review for initial determinations and/or appeals for ASO clients and Medicare Advantage plan.
Collaborate as an integral member of the pharmacy team.
Serve as subject matter expert for pharmacy utilization management.
Ensure timely execution of all drug reviews in compliance with accreditation and regulatory standards.
Work with Medical Director and Clinical Formulary team to review specialty medications requiring a consult.

Requirements

What you’ll need

Must possess current and unrestricted license to practice pharmacy issued by state of residence.
Three (3) years of experience as a pharmacist in a clinical setting.
Two (2) years of managed care experience.
Specific knowledge of CMS regulations, HIPAA and regulatory environment.

Benefits

Comp & perks

Standard office environment
Some travel may be required to offsite meetings

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

drug utilization reviewclinical pharmacymanaged carespecialty medicationspharmacy utilization management

Soft Skills

collaborationsubject matter expertisetimely execution

Certifications

pharmacy license