Clinical Pharmacist – Utilization Management

🔥 13 hours ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $120k - $125k / year

⏰ Full Time

🟢 Junior

💊 Pharmacist

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👻 Ghost score 3%

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Rightway

WebsiteLinkedInAll Job Openings

201 - 500 employees

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

💰 $100M Series C on 2021-03

Healthcare • Healthcare Insurance • SaaS

Rightway is a healthcare company focused on providing care navigation and pharmacy benefits management solutions. It specializes in helping employers and health systems lower healthcare costs and improve outcomes through personalized, proactive clinical support and transparent pharmacy benefits management. Rightway offers a human-first approach, providing real-time, one-on-one support to members to help them make better healthcare decisions and navigate the complexities of healthcare systems. The company aims to reduce healthcare costs while improving employee satisfaction with healthcare services.

📋 Description

• Support all lines of business by reviewing utilization management requests for clinically appropriate and cost-effective coverage • Continually review UM operational processes to ensure effective and compliant delivery of PBM services • Coordinate with Pharmacy Technicians, Pharmacists, and/or Medical Directors on UM activities • Ensure cases are reviewed according to state and federal guidelines, including turnaround-time requirements • Discuss clinical strategy and decision rationale with prescribers as needed • Participate in quality review and inter-rater reliability processes • Support the P&T process, including developing therapeutic class/drug monographs as needed • Research and develop therapy-specific clinical policies and utilization management programs, including Prior Authorization, Step Therapy, Quantity Limit, and Coverage Determination programs • Support Clinical Operations leadership and coordinate with the Pharmacy Navigation team as needed

🎯 Requirements

• Pharmacy Degree Required; PharmD preferred • 1 year experience coordinating medication selection with prescribers and their care teams • Preferred: 1-3+ years of managed care (PBM or health plan) prior authorization experience • Pharmacist license in good standing in state of residence • Willingness to achieve and maintain licensure in multiple states (if needed) • Available to work 40 hours/week • Core operating hours are weekdays within 8 am Eastern Time and 8 pm Eastern Time • Detail-oriented, intellectually and clinically curious, good listener, empathetic, ability to challenge status quo, values exemplar • Great pharmacy benefit knowledge • Effective and creative problem-solving • Ability to prioritize and manage through change • Solid communication skills • Ability to lead projects and influence others without direct reporting-line ownership

🏖️ Benefits

• Bonus • Equity • Potential evening and/or weekend shifts as Rightway grows • On-call approximately once every two months