Columbus, OH · On-site
$54.50 - $65.50/hr
Provide clinical support for utilization management, prior-authorization criteria, and step-therapy ... Active U.S. pharmacist license. * Experience: Managed care, PBM, or health-plan ideal. All ...
Columbus, OH · On-site
$54.50 - $65.50/hr
Provide clinical support for utilization management, prior-authorization criteria, and step-therapy ... Active U.S. pharmacist license. * Experience: Managed care, PBM, or health-plan ideal. All ...
Cleveland, OH · On-site
$56.50 - $67.75/hr
Provide clinical support for utilization management, prior-authorization criteria, and step-therapy ... Active U.S. pharmacist license. * Experience: Managed care, PBM, or health-plan ideal. All ...
Cleveland, OH · On-site
$56.50 - $67.75/hr
Provide clinical support for utilization management, prior-authorization criteria, and step-therapy ... Active U.S. pharmacist license. * Experience: Managed care, PBM, or health-plan ideal. All ...
Columbus, OH · On-site
$54.50 - $65.50/hr
Experience: Managed care or utilization management preferred. Hospital, ambulatory, and community pharmacists with strong documentation and clinical skills are encouraged to apply. * Skills:
Columbus, OH · On-site
$54.50 - $65.50/hr
Experience: Managed care or utilization management preferred. Hospital, ambulatory, and community pharmacists with strong documentation and clinical skills are encouraged to apply. * Skills:
$54.50 - $65.50/hr
The Clinical Pharmacist involves collaborating with multi-disciplinary teams, utilization management, and adhering to organizational and regulatory policies and procedures. Department Summary The ...
$54.50 - $65.50/hr
The Clinical Pharmacist involves collaborating with multi-disciplinary teams, utilization management, and adhering to organizational and regulatory policies and procedures. Department Summary The ...
Canton, OH · On-site
$54.50 - $65.50/hr
The Clinical Pharmacist involves collaborating with multi-disciplinary teams, utilization management, and adhering to organizational and regulatory policies and procedures. Department Summary The ...
Canton, OH · On-site
$54.50 - $65.50/hr
The Clinical Pharmacist involves collaborating with multi-disciplinary teams, utilization management, and adhering to organizational and regulatory policies and procedures. Department Summary The ...
Canton, OH · On-site
$51 - $61.50/hr
The Clinical Pharmacist involves collaborating with multi-disciplinary teams, utilization management, and adhering to organizational and regulatory policies and procedures. Department Summary The ...
Canton, OH · On-site
$51 - $61.50/hr
The Clinical Pharmacist involves collaborating with multi-disciplinary teams, utilization management, and adhering to organizational and regulatory policies and procedures. Department Summary The ...
$54.50 - $65.50/hr
The Clinical Pharmacist involves collaborating with multi-disciplinary teams, utilization management, and adhering to organizational and regulatory policies and procedures. Department Summary The ...
$54.50 - $65.50/hr
The Clinical Pharmacist involves collaborating with multi-disciplinary teams, utilization management, and adhering to organizational and regulatory policies and procedures. Department Summary The ...
Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories ... Well versed in Utilization Management - Must be able to determine elective vs urgent request with ...
Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories ... Well versed in Utilization Management - Must be able to determine elective vs urgent request with ...
Saint Bernard, OH · On-site
$39.34 - $56.20/hr
Wound Care Utilization Management RN Virtual : This role enables associates to work virtually ... Among us are specialty-care physicians, nurse practitioners, pharmacists, engineers, data ...
Saint Bernard, OH · On-site
$39.34 - $56.20/hr
Wound Care Utilization Management RN Virtual : This role enables associates to work virtually ... Among us are specialty-care physicians, nurse practitioners, pharmacists, engineers, data ...
Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories ... May also manage appeals for services denied * Conducts pre-certification, inpatient, retrospective ...
Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories ... May also manage appeals for services denied * Conducts pre-certification, inpatient, retrospective ...
Columbus, OH · On-site
$110K - $132K/yr
... utilization management edits, pharmacy networks, clinical compendia for decision support, FDA ... pharmaceutical market access strategies * Demonstrated success in client facing role(s) or public ...
Columbus, OH · On-site
$110K - $132K/yr
... utilization management edits, pharmacy networks, clinical compendia for decision support, FDA ... pharmaceutical market access strategies * Demonstrated success in client facing role(s) or public ...
Columbus, OH · On-site
$114K - $136K/yr
... utilization management edits, pharmacy networks, clinical compendia for decision support, FDA ... pharmaceutical market access strategies * Demonstrated success in client facing role(s) or public ...
Columbus, OH · On-site
$114K - $136K/yr
... utilization management edits, pharmacy networks, clinical compendia for decision support, FDA ... pharmaceutical market access strategies * Demonstrated success in client facing role(s) or public ...
Columbus, OH · On-site
$114K - $136K/yr
... utilization management edits, pharmacy networks, clinical compendia for decision support, FDA ... pharmaceutical market access strategies * Demonstrated success in client facing role(s) or public ...
Columbus, OH · On-site
$114K - $136K/yr
... utilization management edits, pharmacy networks, clinical compendia for decision support, FDA ... pharmaceutical market access strategies * Demonstrated success in client facing role(s) or public ...
Columbus, OH · On-site
$114K - $136K/yr
... utilization management edits, pharmacy networks, clinical compendia for decision support, FDA ... pharmaceutical market access strategies * Demonstrated success in client facing role(s) or public ...
Columbus, OH · On-site
$114K - $136K/yr
... utilization management edits, pharmacy networks, clinical compendia for decision support, FDA ... pharmaceutical market access strategies * Demonstrated success in client facing role(s) or public ...
$114K - $136K/yr
... utilization management edits, pharmacy networks, clinical compendia for decision support, FDA ... pharmaceutical market access strategies * Demonstrated success in client facing role(s) or public ...
$114K - $136K/yr
... utilization management edits, pharmacy networks, clinical compendia for decision support, FDA ... pharmaceutical market access strategies * Demonstrated success in client facing role(s) or public ...
$114K - $136K/yr
... utilization management edits, pharmacy networks, clinical compendia for decision support, FDA ... pharmaceutical market access strategies * Demonstrated success in client facing role(s) or public ...
$114K - $136K/yr
... utilization management edits, pharmacy networks, clinical compendia for decision support, FDA ... pharmaceutical market access strategies * Demonstrated success in client facing role(s) or public ...
Columbus, OH · On-site
$114K - $136K/yr
... utilization management edits, pharmacy networks, clinical compendia for decision support, FDA ... pharmaceutical market access strategies * Demonstrated success in client facing role(s) or public ...
Columbus, OH · On-site
$114K - $136K/yr
... utilization management edits, pharmacy networks, clinical compendia for decision support, FDA ... pharmaceutical market access strategies * Demonstrated success in client facing role(s) or public ...
Portsmouth, OH · On-site
$91K - $163K/yr
Oversee prior authorizations and utilization management, ensuring compliance with payer and program ... Active pharmacist license in good standing in the state of Ohio Preferred Qualification: * Pharmacy ...
Portsmouth, OH · On-site
$91K - $163K/yr
Oversee prior authorizations and utilization management, ensuring compliance with payer and program ... Active pharmacist license in good standing in the state of Ohio Preferred Qualification: * Pharmacy ...
Portsmouth, OH · On-site
$91K - $163K/yr
Oversee prior authorizations and utilization management, ensuring compliance with payer and program ... Active pharmacist license in good standing in the state of Ohio Preferred Qualification: * Pharmacy ...
Portsmouth, OH · On-site
$91K - $163K/yr
Oversee prior authorizations and utilization management, ensuring compliance with payer and program ... Active pharmacist license in good standing in the state of Ohio Preferred Qualification: * Pharmacy ...
Gratiot, OH · On-site
$75/hr
They schedule 3 RPh's working on the counter in addition to the RPh manager. Because of this ... utilization, therapeutic duplications, disease state, drug interaction, drug allergy, dosage and ...
Gratiot, OH · On-site
$75/hr
They schedule 3 RPh's working on the counter in addition to the RPh manager. Because of this ... utilization, therapeutic duplications, disease state, drug interaction, drug allergy, dosage and ...
A Utilization Management Pharmacist is responsible for evaluating prescription drug use to ensure cost-effective and evidence-based treatment. They review prior authorization requests, assess medication appropriateness, and collaborate with healthcare providers to optimize patient outcomes. They work in insurance companies, pharmacy benefit managers (PBMs), or healthcare organizations to enforce formulary compliance and reduce unnecessary healthcare costs. Their role helps balance patient care with financial stewardship by ensuring medications meet clinical guidelines and coverage policies.
As a Utilization Management Pharmacist, your daily responsibilities often include reviewing medication requests for appropriateness, evaluating coverage under insurance plans, and ensuring adherence to clinical guidelines. You will regularly collaborate with physicians, nurses, case managers, and insurance representatives to optimize medication therapy and manage prior authorizations. Providing clinical recommendations, supporting appeals processes, and participating in the development of drug utilization policies are also common aspects of the role. This position offers a blend of independent decision-making and teamwork, allowing you to have a meaningful impact on patient care while coordinating with a variety of healthcare professionals.
To thrive as a Utilization Management Pharmacist, candidates typically need a Doctor of Pharmacy (PharmD) degree, current pharmacist licensure, and a solid understanding of clinical guidelines and formulary management. Familiarity with pharmacy benefit management (PBM) software, electronic medical records (EMR) systems, and utilization review processes is commonly required, along with certification such as Board Certified Pharmacotherapy Specialist (BCPS) being advantageous. Strong analytical skills, attention to detail, effective communication, and the ability to work collaboratively with healthcare providers make someone stand out in this position. These competencies are crucial for ensuring safe, effective, and cost-efficient medication use while supporting optimal patient outcomes within healthcare organizations.
The most popular types of Utilization Management Pharmacist jobs in Ohio are:
For Utilization Management Pharmacist jobs in Ohio, the most frequently searched job titles are:
The top searched job categories for Utilization Management Pharmacist jobs in Ohio are:
$54.50 - $65.50/hr
Other
Posted 14 days ago
Formulary Management Pharmacist - Influence Therapy Access at Scale | Hybrid/Remote Friendly
Shape which medications patients can access by evaluating new drugs, analyzing clinical and economic data, and supporting P&T; Committee decisions. This role offers strong intellectual challenge and often hybrid or remote flexibility.
Key Responsibilities
