Remote Utilization Review Manager Jobs in Sparta, NJ

Job Description Summary

The Clinical Pharmacist I supports clinical pharmacy programs by performing medication therapy review, drug utilization review, patient and provider outreach, and medication-related quality initiative support within established protocols. This job applies clinical pharmacy training to routine patient care situations.
Clinical Pharmacist I makes clinical decisions within defined scope, with close guidance from senior clinical pharmacy staff. This job builds practical experience in value-based care, medication adherence, high-risk medication review, and interdisciplinary collaboration while contributing to safe, effective, and affordable medication use.

How will you make an impact & Requirements

KEY RESPONSIBILITIES

• Conduct medication therapy reviews and targeted patient outreach for routine clinical pharmacy initiatives under established protocols.

• Review medication-related quality care gaps, including adherence and statin-use opportunities, and support patient or provider follow-up to improve outcomes.

• Assess prescription histories, medication lists, refill patterns, and basic drug utilization information to identify issues requiring pharmacist intervention or escalation.

• Collaborate with providers, care managers, pharmacy technicians, and other care team members to support medication adherence, safety, affordability, and access.

• Educate patients and caregivers on medication use, adherence barriers, affordability resources, and pharmacist-approved care plan actions within scope.

• Document clinical assessments, outreach results, recommendations, and follow-up actions accurately in applicable systems.

• Review pharmacy technician-collected medication histories and outreach documentation for accuracy and clinical relevance as needed.

• Perform comprehensive utilization management reviews for Medicare Part B-covered medical drugs, including evaluation of medical necessity, alignment with FDA labeling and compendia-supported indications, prior authorization requests, step therapy protocols, and site-of-care optimization to support cost-effective, high-quality outcomes while minimizing total cost of care.

• Collaborate cross-functionally with medical directors, providers, and care management teams on Part B and Part D drug utilization trends, denial/appeal processes, and exception requests; apply evidence-based criteria and Medicare coverage determinations to ensure appropriate utilization, support Stars/HEDIS quality measures, and drive value-based care initiatives such as biosimilar adoption and transitions from hospital outpatient to lower-cost infusion settings.

• Participate in an interdisciplinary Model of Care for Medicare Special Needs Populations.

QUALIFICATIONS

• Doctor of Pharmacy degree or other pharmacy degree from an ACPE-accredited College of Pharmacy required.

• Active, unrestricted pharmacist license in the applicable state of practice required;collaborative practice certification, or related advanced credential may be required based on patient population and business need

• Additional state pharmacist licenses may be required based on patient population and business need or willingness to obtain as required.

• Completion of accredited pharmacy training required; residency, managed care experience, ambulatory care experience, or value-based care experience preferred.

• Basic knowledge of medication therapy management, drug utilization review, medication adherence, quality measures, patient counseling, and provider collaboration.

Benefits:

• 3 weeks PTO & 8 paid holidays

• Medical, Dental, Vision

• Employer Paid Basic Life & Short Term Disability coverage (goes into effect after 1 year of full-time employment)

• 401(k) with match

• Employee Wellness

• Other Employee Discount programs like Tickets at Work and cell phone discounts

• Other benefits: Dependent Care FSA, Voluntary Life, Long Term Disability, Critical Illness, Pet Insurance, and more

Why Millennium?

Millennium Physician Group is one of the largest comprehensive primary care practices with healthcare providers throughout Florida.

At Millennium Physician Group, you will find an organization that focuses on family and building a strong network of people to care for the communities we serve. We are always searching for employees who have a strong customer service attitude, fantastic teamwork skills and a willing smile ready to share.

Our promise is to provide you with the tools to do your job successfully, as well as providing a team atmosphere that empowers you to seek better ways to deliver care to our patients and their families. We also promise to care for you as an individual, and help you grow in your role with Millennium Physician Group.

If you are interested in joining an organization that puts an emphasis on team work and family, then Millennium Physician Group is the right choice.

Compensation Range:

$124,681.00

to

$187,022.00

The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.