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Remote Utilization Management Pharmacist Jobs in California

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Remote Utilization Management Pharmacist information

What is a remote utilization management pharmacist?

A Remote Utilization Management Pharmacist is a licensed pharmacist who works from a non-traditional setting, such as home, to review medication use and ensure that prescribed drugs are medically necessary, cost-effective, and aligned with clinical guidelines. They collaborate with healthcare providers, insurance companies, and patients to optimize medication therapy while controlling costs and preventing unnecessary treatments. Their work often involves evaluating prior authorization requests, reviewing patient medication histories, and providing recommendations for alternative therapies when appropriate.

How does a remote utilization management pharmacist typically collaborate with other healthcare professionals while working offsite?

Remote Utilization Management Pharmacists work closely with physicians, nurses, and case managers primarily through secure digital platforms and regular conference calls. They review medication requests, provide clinical recommendations, and help ensure patients receive appropriate therapies in line with established guidelines. Effective communication and timely documentation are essential, as collaboration often relies on electronic health records and virtual meetings. Building strong professional relationships remotely can be a challenge, but most organizations provide robust digital tools and dedicated support teams to facilitate seamless interaction.

What are the key skills and qualifications needed to thrive as a remote utilization management pharmacist, and why are they important?

To thrive as a Remote Utilization Management Pharmacist, you need a Doctor of Pharmacy (PharmD) degree, active pharmacist licensure, and experience in medication review and clinical decision-making. Familiarity with pharmacy benefit management (PBM) systems, electronic health records (EHRs), and utilization management software is typically required. Strong analytical skills, attention to detail, and effective written communication are vital for evaluating medication requests and collaborating with healthcare providers. These competencies ensure appropriate medication use, regulatory compliance, and optimal patient outcomes in a remote healthcare setting.

What is the difference between Remote Utilization Management Pharmacist vs Remote Pharmacy Benefits Manager?

AspectRemote Utilization Management PharmacistRemote Pharmacy Benefits Manager
CredentialsPharmacy license, certification in utilization reviewPharmacy license, health plan or benefits management experience
Work EnvironmentHealthcare organizations, insurance companies, telehealth platformsHealth insurance companies, pharmacy benefit management firms
Industry UsageFocuses on medication review, prior authorizations, and clinical decision supportOversees pharmacy benefit plans, formulary management, and cost control strategies

While both roles involve pharmacy expertise and work remotely, the Remote Utilization Management Pharmacist primarily reviews medication appropriateness and manages prior authorizations, whereas the Remote Pharmacy Benefits Manager focuses on managing pharmacy benefit plans and formulary strategies. Understanding these distinctions helps professionals choose the role that best aligns with their skills and career goals.

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

The most popular types of Utilization Management Pharmacist jobs in California are:

What are popular job titles related to Remote Utilization Management Pharmacist jobs in California?

For Remote Utilization Management Pharmacist jobs in California, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Management Pharmacist jobs in California look for?

The top searched job categories for Remote Utilization Management Pharmacist jobs in California are:

What cities in California are hiring for Remote Utilization Management Pharmacist jobs?

Cities in California with the most Remote Utilization Management Pharmacist job openings:

Remote Utilization Management Pharmacist jobs near you
Infographic showing various Remote Utilization Management Pharmacist job openings in California as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution.

Medical Reviewer (Pharmacist) - Remote CA

Gainwell Technologies LLC

West Sacramento, CA • Remote

$100K - $140K/yr

Full-time

Medical, Life, Retirement, PTO

Posted yesterday

New

Gainwell Technologies rating

7.8

Company rating: 7.8 out of 10

Based on 82 frontline employees who took The Breakroom Quiz

139th of 246 rated software companies

Job description

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary

Gainwell Technologies is seeking a Medical Reviewer (Pharmacist) to provide pharmacy and clinical expertise supporting Medical Review Services for California healthcare programs. This role supports pharmacy review, claim adjudication, drug rebate activities, drug utilization review, Treatment Authorization Requests (TARs), and other Medical Review Services functions.

Your role in our mission
  • Perform pharmacy and medication-related clinical reviews.
  • Support pharmacy claim review and adjudication activities.
  • Provide clinical expertise for drug utilization review and drug-related authorization requests.
  • Support drug rebate and pharmacy program activities as assigned.
  • Review pharmacy documentation for compliance with applicable policies and coverage requirements.
  • Provide technical expertise and assistance related to pharmacy review.
  • Document findings and recommendations accurately and timely.
  • Collaborate with physicians, nurses, pharmacy teams, operations, and other healthcare professionals.
  • Maintain knowledge of applicable pharmacy policies and regulatory requirements.
What we're looking for
  • Current, non-expired pharmacist license from the State of California, in good standing.
  • Must not be under suspension from Medicare, Medicaid, or pharmacy practice in California.
  • Must not have been previously sanctioned for fraud or abuse.
  • Three (3) years of previous experience as a pharmacy consultant for a government or private-sector healthcare payer; or one (1) year of MMIS experience in a large state providing technical expertise and assistance for pharmacy review.
  • Strong oral and written communication skills.
  • Strong knowledge of pharmacy practices, medication review, and healthcare reimbursement processes.
What you should expect in this role
  • Full-time position.
  • Remote work environment.
  • Monday through Friday work schedule.
  • Work primarily from your home office while supporting Medical Review Services for California healthcare programs.
  • Spend the majority of your day reviewing pharmacy, clinical, claim, authorization, and supporting documentation.
  • Work independently while collaborating with physicians, pharmacists, nurses, other clinical specialists, operations teams, and business partners.
  • Navigate multiple computer systems and applications to complete reviews, document findings, and support timely determinations.
  • Maintain all professional licenses, certifications, and credentials required for the position in active, unrestricted, and good-standing status.
  • Maintain knowledge of applicable medical and pharmacy policies, coverage requirements, clinical standards, and regulatory guidelines.
  • Meet established quality, accuracy, productivity, and turnaround-time expectations.
  • Receive ongoing training and support related to program requirements, systems, policies, and medical review processes.
  • Travel requirement: 0-10%.

This position is being posted for pipeline purposes, and we welcome applications on an ongoing basis.

#LI-REMOTE

#LI-MA1

The pay range for this position is $100,000 - $140,000 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

What Gainwell Technologies employees say

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Hours and flexibility

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About Gainwell Technologies

Sourced by ZipRecruiter

With Health and Cost outcomes that pierce Inequities and Impact Economies, the success of our Nation’s Federal Medicaid program is inextricably tied to the Prosperity of Communities, States and the Nation as a whole. We think that deserves Respect and a Commitment from Innovators who can help those who operate within and around health and human services evolve to meet their goals. At Gainwell, that’s our Sole focus. Built across more than Five Decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet Agencies, Health plans and MCOs where they are on their modernization journeys and propel them into the future of Healthcare. Equally important to our Expanding Technologies and Results. We bring ideas that bring policies to life.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Irving, TX, US

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