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Full Time Utilization Management Pharmacist Jobs

UPMC Health Plan

UM Care Manager (RN)

Pittsburgh, PA · Remote

We are hiring a full-time Utilization Management Care Manager to support the Utilization Management Clinical Operations Department. This position will predominantly work from home, standard daylight ...

Centene

Director, Utilization Management

$133K - $247K/yr

Leads utilization management team on performance, improvement, and career growth path ... full-time or part-time status. Total compensation may also include additional forms of incentives.

Lthc

Clinical Pharmacist, Utilization Management

Dewitt, MI

$99K - $118K/yr

... Pharmacist * Pharm.D. In lieu of a Pharm.D., a Bachelors in Pharmacy is required. * Managed care experience is strongly preferred, especially experience in utilization management. In lieu of managed ...

New

Lthc

Clinical Pharmacist, Utilization Management

Utica, NY

$121K - $144K/yr

... Pharmacist * Pharm.D. In lieu of a Pharm.D., a Bachelors in Pharmacy is required. * Managed care experience is strongly preferred, especially experience in utilization management. In lieu of managed ...

New

Lthc

Clinical Pharmacist, Utilization Management

Albany, NY

$117K - $140K/yr

... Pharmacist * Pharm.D. In lieu of a Pharm.D., a Bachelors in Pharmacy is required. * Managed care experience is strongly preferred, especially experience in utilization management. In lieu of managed ...

New

Lthc

Clinical Pharmacist, Utilization Management

Dewitt, MI · On-site

$99K - $118K/yr

... Pharmacist * Pharm.D. In lieu of a Pharm.D., a Bachelors in Pharmacy is required. * Managed care experience is strongly preferred, especially experience in utilization management. In lieu of managed ...

New

Lthc

Clinical Pharmacist, Utilization Management

Utica, NY · On-site

$121K - $144K/yr

... Pharmacist * Pharm.D. In lieu of a Pharm.D., a Bachelors in Pharmacy is required. * Managed care experience is strongly preferred, especially experience in utilization management. In lieu of managed ...

New

Lthc

Clinical Pharmacist, Utilization Management

Buffalo, NY

$114K - $137K/yr

... Pharmacist * Pharm.D. In lieu of a Pharm.D., a Bachelors in Pharmacy is required. * Managed care experience is strongly preferred, especially experience in utilization management. In lieu of managed ...

New

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Full Time Utilization Management Pharmacist information

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How much do full time utilization management pharmacist jobs pay per hour?

As of Sep 2, 2026, the average hourly pay for full time utilization management pharmacist in the United States is $58.10, according to ZipRecruiter salary data. Most workers in this role earn between $46.63 and $68.75 per hour, depending on experience, location, and employer.

What is a full time utilization management pharmacist?

Full Time Utilization Management Pharmacists are licensed pharmacists who work primarily to evaluate and manage the appropriate use of medications within healthcare systems, often for insurance companies or pharmacy benefit managers. Their role includes reviewing medication requests, ensuring prescriptions meet evidence-based guidelines, and collaborating with healthcare providers to optimize patient outcomes while controlling costs. They work standard full-time hours and focus on clinical decision-making, policy development, and utilization reviews rather than dispensing medications.

What are the key skills and qualifications needed to thrive as a full time utilization management pharmacist?

To thrive as a Full Time Utilization Management Pharmacist, you need a Doctor of Pharmacy (PharmD) degree, state licensure, and strong knowledge of drug therapies, formulary management, and clinical guidelines. Expertise with pharmacy benefit management (PBM) systems, electronic health records (EHRs), and prior authorization platforms is typically required. Exceptional communication, analytical thinking, and attention to detail are crucial for collaborating with healthcare providers and ensuring optimal patient outcomes. These competencies enable pharmacists to effectively evaluate medication use, promote cost-effective care, and uphold regulatory standards in managed care environments.

What are some common challenges faced by full time utilization management pharmacists, and how can they be addressed?

Full Time Utilization Management Pharmacists often encounter challenges such as balancing clinical guidelines with insurance policy requirements, managing high volumes of prior authorization requests, and communicating effectively with healthcare providers. Staying updated on formulary changes and payer criteria is essential. Building strong relationships with providers and utilizing technology to streamline workflows can help mitigate these challenges and ensure patients receive appropriate and timely care.

What is the difference between Full Time Utilization Management Pharmacist vs Utilization Review Pharmacist?

AspectFull Time Utilization Management PharmacistUtilization Review Pharmacist
CredentialsPharmacy Degree, Licensure, Certification in Utilization ManagementPharmacy Degree, Licensure, Certification in Utilization Review
Work EnvironmentHealthcare organizations, insurance companies, managed care settingsInsurance companies, healthcare providers, managed care organizations
Job FocusManaging medication utilization, reviewing prior authorizations, ensuring appropriate drug useAssessing medical necessity, reviewing patient cases, approving or denying coverage
Industry UsageCommon in managed care and insurance sectorsCommon in insurance and healthcare provider settings

The Full Time Utilization Management Pharmacist primarily focuses on medication management and prior authorization processes within healthcare organizations. In contrast, the Utilization Review Pharmacist concentrates on evaluating medical necessity and approving coverage for treatments. Both roles require similar credentials but differ in their specific responsibilities and work environments.

What cities are hiring for Full Time Utilization Management Pharmacist jobs?

Cities with the most Full Time Utilization Management Pharmacist job openings:

What are the most commonly searched types of Utilization Management Pharmacist jobs?

The most popular types of Utilization Management Pharmacist jobs are:

What states have the most Full Time Utilization Management Pharmacist jobs?

States with the most job openings for Full Time Utilization Management Pharmacist jobs include:

Full Time Utilization Management Pharmacist jobs near you

Utilization Specialist - Full Time

Acadia Healthcare

Scotts Valley, CA • On-site

$25 - $27/hr

Full-time

Medical, Dental, Vision, Retirement

Re-posted 2 days ago

Acadia Healthcare rating

6.2

Company rating: 6.2 out of 10

Based on 191 frontline employees who took The Breakroom Quiz

699th of 898 rated healthcare providers

Job description

Overview
Utilization Specialist Opportunity (8hours shifts) at The Camp Recovery Center - Scotts Valley, CA
Pay Range$25.00 - $27.00:
We are hiring a compassionate and experienced Utilization Specialist to work with our clients at The Camp Recovery Center in Scotts Valley! This is a key role whose primary goal is to provide a safe, nurturing environment for our adult clients who have co-occurring disorders (substance use disorder and mental health disorders). The Camp is a 74-bed treatment center providing services to adults on both an inpatient and outpatient basis.
Medi-Cal Experience and Understanding Preferred
Responsibilities
ESSENTIAL FUNCTIONS:
  • Act as liaison between managed care organizations and the facility professional clinical staff.
  • Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
  • Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
  • Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
  • Conduct quality reviews for medical necessity and services provided.
  • Facilitate peer review calls between facility and external organizations.
  • Initiate and complete the formal appeal process for denied admissions or continued stay.
  • Assist the admissions department with pre-certifications of care.
  • Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.

OTHER FUNCTIONS:
  • Perform other functions and tasks as assigned.

Qualifications
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
  • Required Education: High school diploma or equivalent.
  • Preferred Education: Associate's, Bachelor's, or Master's degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
  • Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred
  • UM Experience preferred
  • Medi-Cal experience and understanding preferred

LICENSES/DESIGNATIONS/CERTIFICATIONS:
  • Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
  • CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.
  • First aid may be required based on state or facility requirements.

COMPENSATION:
Compensation for roles at THE CAMP RECOVERY CENTER varies depending on a wide array of factors including but not limited to the specific location, role, skill set, and level of experience. As required by local law, THE CAMP RECOVERY CENTER provides a reasonable hourly range of compensation for roles that may be hired in California as set forth below.
Role Location: CALIFORNIA
Calculated Hourly Range for role Utilization Specialist
State - California: $25.00 - $27.00
BENEFITS: For Full Time Staff only
The Camp Recovery Center provides a comprehensive package of benefits for our Full Time Utilization Specialist.. Current benefits include:
  • Competitive hourly rate
  • Shift differential for overnight shifts
  • Medical, dental, and vision insurance
  • Acadia Healthcare 401(k) plan
  • Excellent training program
  • Complimentary AOD Education to certify as a Substance Use Disorder Counselor
  • Professional growth opportunity that is second to none in the industry.

AVAILABLE SHIFTS AND HOURS:
This is a Full-Time EMT position Monday - Friday . Shifts are 8 - hours, and are overtime eligible
ADDITIONAL REGULATORY REQUIREMENTS:
As Needed
While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances
(e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.
We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws.

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About Acadia Healthcare

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Acadia Healthcare is a leading provider in the healthcare and hospital industry, based in Franklin, Tennessee, United States. The company is recognised for its commitment to creating a behavioural health network that provides accessible, high-quality treatment options for individuals suffering from mental health issues, addiction, eating disorders, and PTSD. Acadia Healthcare was founded in 2005, with the mission to create a world-class organization that sets the standard of excellence in the treatment of specialty behavioural health and addiction disorders.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Franklin, TN, US

Year founded

2005

Social media

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