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Remote Utilization Management Pharmacist Jobs in Wisconsin

Bcbsa

$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 ...

NV5

Remote Sensing Technician

Sheboygan Falls, WI · Remote

... Developers, IT, Project Management Professionals, and more. At NV5 Geospatial, we are a ... Proficient and experienced in utilization of cloud-based technology * Capable of independent ...

NV5

Remote Sensing Technician

Sheboygan Falls, WI · On-site +1

... Developers, IT, Project Management Professionals, and more. At NV5 Geospatial, we are a ... Proficient and experienced in utilization of cloud-based technology * Capable of independent ...

CSAA

... management review * Lead operational governance activities across assigned Clubs, including ... Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements

CSAA

... management review * Lead operational governance activities across assigned Clubs, including ... Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements

CSAA

... management review * Lead operational governance activities across assigned Clubs, including ... Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements

CSAA

... management review * Lead operational governance activities across assigned Clubs, including ... Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements

Cayenta

Work with colleagues and managers to implement and proactively manage superior utility CIS ... utilization of assigned resources. * Be a leader in providing subject matter expertise to R&D and ...

Cayenta

Work with colleagues and managers to implement and proactively manage superior utility CIS ... utilization of assigned resources. * Be a leader in providing subject matter expertise to R&D and ...

Bcbsa

$150K - $200K/yr

The Director of Audit is responsible for overseeing the organization's client and pharmaceutical ... Risk Management and Compliance. 35% * Collaborate with Finance, Legal, and IT to strengthen ...

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Remote Utilization Management Pharmacist information

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 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.

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 Wisconsin? The most popular types of Utilization Management Pharmacist jobs in Wisconsin are:
What are popular job titles related to Remote Utilization Management Pharmacist jobs in Wisconsin? For Remote Utilization Management Pharmacist jobs in Wisconsin, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management Pharmacist jobs in Wisconsin look for? The top searched job categories for Remote Utilization Management Pharmacist jobs in Wisconsin are:
What cities in Wisconsin are hiring for Remote Utilization Management Pharmacist jobs? Cities in Wisconsin with the most Remote Utilization Management Pharmacist job openings:
Remote Utilization Management Pharmacist jobs near you

Director, Trade Client Relations

Bcbsa

Remote

$155K - $175K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 5 days ago

Job description

Synergie Medication Collective is a new medication contracting organization founded by a group of Blue Cross and Blue Shield affiliated companies to serve both Blues and select independent health plans. Synergie is focused on improving affordability and access to costly medical benefit drugs - ones that are injected or infused by a health care professional in a clinical setting - for nearly 100 million Americans. The Trade Client Strategy Director liaises with Synergie Participants and manages clinical policies to comply with manufacturer contracts, implements Trade strategies and initiatives, and collaborates with and supports Synergie's Client Relations team for Trade related inquiries. This includes medical and pharmacy drug policies, cross benefit management, and rebate qualification for manufacturer contracts. This position will establish and maintain cross functional partnerships with internal teams to drive the identification, development and successful execution of Synergie's rebate programs. This position will be the primary Trade point of contact for Synergie's Participant facing activities and will support clinical decision making at the Participant level to comply with manufacturer contracts.

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 - $175,000.00

This 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.

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