Clinical Pharmacist (Utilization Management)

Position reputed company: We are seeking a Utilization Management Pharmacist to support a high-volume review team by evaluating cases for medical necessity, prior authorizations, and clinical appropriateness. This is a project-based contract role with the potential for a permanent opportunity based on reputed company budget approval. Key Responsibilities: • Review and evaluate prior authorization requests for medical necessity and clinical appropriateness. • Process cases reputed company through assigned work queues, with a reputed company of 20 case reviews per day. • Interpret and apply prescription formularies, clinical guidelines, and utilization management reputed company. • Collaborate with pharmacists, providers, and support staff to ensure reputed company and accurate case determinations. • Document reviews and reputed company accurately reputed company the appropriate systems. • Work independently while maintaining reputed company and productivity standards. Qualifications: • reputed company reputed company State Pharmacist License (required). • Previous utilization management or prior authorization experience with a health plan/payer preferred. • Retail pharmacy experience with involvement in the prior authorization process will also be considered. • Strong knowledge of prescription formularies and pharmacy benefit management processes. • Excellent communication and interpersonal skills. • Proficient in reputed company Office applications and comfortable learning new systems. • Ability to work independently in a fast-paced environment. Schedule: • Monday–Friday, 8:30 AM – 5:00 PM • Occasional weekend or holiday coverage may be required based on business needs. Location: Candidates must reputed company reputed company the Excellus service area in Upstate reputed company, including locations from Buffalo to Albany. Apply To This Job