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Full Time Utilization Management Pharmacist Jobs

Acadia Healthcare

Utilization Specialist

Ocklawaha, FL · On-site

$20 - $24/hr

We are looking to for a Full Time Utilization Review Specialist to join our team. The UR specialist ... Act as liaison between managed care organizations and the facility professional clinical staff.

New

Sutter Health

Care Management Pharmacist

Sacramento, CA · On-site

$172K - $241K/yr

... utilization reviews and coverage determinations in accordance with applicable state and federal ... Days Schedule: Full Time Days of the Week: Monday - Friday Weekend Requirements: None Benefits: Yes ...

Dignity Health Management Services

$57.37 - $85.33/hr

Job Summary and Responsibilities As our UM RN (Utilization Management Registered Nurse), you will ... EZCap experience a plus Employment Type: Full Time

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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 Jul 26, 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 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 are the key skills and qualifications needed to thrive as a Full Time Utilization Management Pharmacist, and why are they important?

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 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 are Full Time Utilization Management Pharmacists?

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 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

Utilization Specialist

The Refuge, A Healing Place

Ocklawaha, FL

$20 - $24/hr

Full-time

Posted 3 days ago

Job description

Overview

Are you prepared for the impact you can make in your UR career at a well-respected treatment center in Ocklawaha, Florida? If so, you may enjoy working at The Refuge, a Healing Place, an trauma treatment facility set on 96-acre campus located in the Ocala National Forest.  The Refuge provides premier residential treatment for adults aged 18 and older who are struggling with substance use disorders, behavioral health, trauma, eating disorder and other co-occurring disorders. 

We are looking to for a Full Time Utilization Review Specialist to join our team. The UR specialist proactively monitors utilization of services for patients to optimize reimbursement for the facility. This is a Monday-Friday, day position working 40 hours per week.

PURPOSE STATEMENT: 

Proactively monitor utilization of services for patients to optimize reimbursement for the facility.  

Pay for this position ranges from $20 - $24/hr based on relevant work experience.

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 

LICENSES/DESIGNATIONS/CERTIFICATIONS:  

  • 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. 

 

ADDITIONAL REGULATORY REQUIREMENTS: 

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.

REFHP

Employment Type: FULL_TIME

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