Gaithersburg, MD · Remote
$155K - $175K/yr
... PBM), utilization management, pharmaceutical contracting, client relations, or analytical ... Work is generally performed in a remote setting. #LI-Remote $155,000.00 - $175,000.00 This is the ...
Gaithersburg, MD · Remote
$155K - $175K/yr
... PBM), utilization management, pharmaceutical contracting, client relations, or analytical ... Work is generally performed in a remote setting. #LI-Remote $155,000.00 - $175,000.00 This is the ...
$29.01 - $33.40
2% of jobs
$33.40 - $37.79
0% of jobs
$37.79 - $42.17
0% of jobs
$42.17 - $46.56
0% of jobs
$46.56 - $50.95
5% of jobs
$50.95 - $55.34
9% of jobs
$58.17 is the 25th percentile. Wages below this are outliers.
$55.34 - $59.73
13% of jobs
The median wage is $63.80 / hr.
$59.73 - $64.11
22% of jobs
$64.11 - $68.50
21% of jobs
$69.08 is the 75th percentile. Wages above this are outliers.
$68.50 - $72.89
18% of jobs
$72.89 - $77.28
9% of jobs
$29
$63
$77
A Remote PBM (Pharmacy Benefit Manager) Pharmacist is a licensed pharmacist who works remotely to manage prescription drug benefits for health plans, insurance companies, and employers. Their responsibilities typically include reviewing medication approvals, ensuring formulary compliance, conducting drug utilization reviews, and providing clinical support. They help optimize medication therapies, reduce costs, and improve patient outcomes. This role often involves collaboration with healthcare providers and insurance teams to ensure appropriate medication use. It requires strong analytical skills, knowledge of pharmacy regulations, and proficiency with PBM software systems.
A typical workday for a Remote PBM Pharmacist involves reviewing and processing prescription drug claims, conducting medication prior authorization reviews, and supporting formulary management decisions. You may spend much of your day collaborating virtually with healthcare providers, insurance representatives, and other pharmacists to resolve medication issues and optimize patient outcomes. Most roles require strong organizational skills and the ability to manage multiple cases simultaneously while maintaining regulatory compliance. You'll often use specialized pharmacy benefit management software and participate in team meetings or case discussions via secure online platforms. The remote nature of the job provides flexibility but also requires self-motivation and effective communication to ensure seamless coordination with your team.
To thrive as a Remote PBM Pharmacist, you need a Doctor of Pharmacy (PharmD) degree, a current pharmacist license, and experience in pharmacy benefit management (PBM) or managed care settings. Familiarity with pharmacy claims systems, formulary management software, and proficiency in using secure telehealth platforms are crucial technical requirements. Strong attention to detail, problem-solving abilities, and effective remote communication skills help you excel in a virtual team environment. These capabilities ensure accurate medication reviews, efficient claim adjudication, and quality service to patients and healthcare partners from a remote location.
For Remote Pbm Pharmacist jobs in Reston, VA, the most frequently searched job titles are:
The top searched job categories for Remote Pbm Pharmacist jobs in Reston, VA are:
Cities near Reston, VA with the most Remote Pbm Pharmacist job openings:
$155K - $175K/yr
Full-time
Medical, Dental, Vision, Retirement, PTO
Posted 23 days ago
Primary Job Functions
Consult with Client Relations team on Trade related inquiries, initiatives, and opportunity pull through with Participants
Understands downstream impact of rebate and formulary strategy and can convey appropriate messaging to health plan participants for adoption of said strategies and policies
Has working knowledge of PBM operations and understanding of drug and UM strategy and policy implementation
Has experience in reading and interpreting pharmaceutical manufacturer drug contracts and understanding how to align terms and conditions and translate into UM policy and criteria
Manage medical and pharmacy clinical policies with Participants to ensure manufacturer contract compliance
Collaborate and support Client Relations team for Trade related inquiries from Participants
Partner with the following stakeholders:
Analytics Team - Collaborate on drug trends and utilization data to inform clinical policy decisions, medical policy and formulary compliance, drug share shift and utilization management strategies
Client Relations - Serve as Trade's primary point of contact for all Participant questions on Trade initiatives and manufacturer contracts and escalate issues as needed to Trade's leadership
Clinical Team - Liaise with Clinical team to review clinical data and policy requirements as needed
Invoicing Team - Maintain current library of Participant medical and pharmacy policies and support Invoicing team with manufacturer inquiries regarding clinical policies
Product Team - Provide medical policy support for manufacturer related contracts including, but not limited to, cell and gene therapies and other outcomes programs
Education, Experience, and Certification
Pharmacy degree and Pharm D. preferred
5-7 years of related work experience in healthcare, pharmacy benefit management (PBM), utilization management, pharmaceutical contracting, client relations, or analytical contracting
Must be eligible to work in the United States without need for work visa or residency sponsorship
Excellent verbal and written presentation skills
Ability to establish rapport and build relationships at all levels within an organization
Practical application of clinical data to drive financial value
Strong business and financial acumen, with advanced proficiency in Excel and PowerPoint
Knowledge, Skills, and Abilities
Pharmacy residency training or equivalent experience
Experience within the PBM industry, Medicaid, Medicare, and health plans
Experience with contract language and risk mitigation concepts
Travel Requirements: Up to 10% of the time.
Work is generally performed in a remote setting.
#LI-Remote
$155,000.00 - $175,000.00This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range and this hiring range may also be modified in the future. A candidate's position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.This job is also eligible for annual bonus incentive pay.
We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.
Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.