PBM Utilization Management Pharmacist

Job not on LinkedIn

🔥 12 hours ago

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $125k - $130k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

💊 Pharmacist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 18%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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UNITAS

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2021

🏥 Healthcare

💼 Consulting

🎯 Recruiter

Healthcare • Consulting • Recruitment

UNITAS is a clinician-led staffing and consulting firm founded in 2021 that specializes in recruiting clinical, operational, and leadership talent for pharmacy benefit managers (PBMs) and related healthcare organizations. They provide contract-to-hire, direct hire, temporary staff augmentation, and operational/clinical consulting services, vet candidates through licensed clinicians, and emphasize high retention and strong client/candidate experience across the United States.

📋 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 according to URAC/NCQA utilization review standards • Provide support to members, prescribers, and pharmacies by responding to clinical inquiries via phone • Apply current clinical prescribing guidelines, internal policies, and regulatory changes • Follow 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 team members • Assist leadership with special projects, process improvements, and operational initiatives

🎯 Requirements

• Active, unrestricted pharmacist license • Bachelor’s or Doctor of Pharmacy degree • Minimum of 2 years of pharmacy practice experience • 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 preferred • Minimum of 6 months prior authorization or utilization management experience preferred • Experience in managed care or pharmacy benefit management (PBM) preferred