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Utilization Management Pharmacist Jobs (NOW HIRING)

Ampcus

Spec, Utilization Management

Baltimore, MD · On-site

Spec, Utilization Management Job Location: Baltimore, MD Utilizing key principles of utilization ... pharmaceutical references (i.e. FDA, National Comprehensive Cancer Network, Clinical trials.Gov ...

ICONMA

Spec, Utilization Management

Spec, Utilization Management Our client, a Health Insurance company, is looking for a Spec ... pharmaceutical references (i.e. FDA, National Comprehensive Cancer Network, Clinical trials.Gov ...

Hire Talent

TEMP_NEO_Staff Pharmacist

$61 - $71.75/hr

Staff Pharmacist (Utilization Management) We are seeking a staff pharmacist to support utilization management (UM) activities. This role is responsible for reviewing prior authorization requests ...

Judi Health

Formulary Operations Pharmacist

Manhattan, NY · On-site

$64.25 - $77.25/hr

Formulary Operations Pharmacist Charlotte, North Carolina, United States; Denver, Colorado, United ... This individual supports creation and maintenance of formulary and utilization management lists ...

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Utilization Management Pharmacist information

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How much do utilization management pharmacist jobs pay per hour?

As of Aug 7, 2026, the average hourly pay for utilization management pharmacist in the United States is $58.10, according to ZipRecruiter salary data. Most workers in this role earn between $46.63 and $68.75 per hour, depending on experience, location, and employer.

What are the typical responsibilities of a utilization management pharmacist, and how do they interact with other healthcare professionals?

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.

What are the key skills and qualifications needed to thrive in the utilization management pharmacist position, and why are they important?

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.

What is a utilization management pharmacist?

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.

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What cities are hiring for Utilization Management Pharmacist jobs? Cities with the most Utilization Management Pharmacist job openings:
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Utilization Management Pharmacist jobs near you
Infographic showing various Utilization Management Pharmacist job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 88% Physical, 2% Hybrid, and 10% Remote job distribution, with an average salary of $120,850 per year, or $58.1 per hour.

Spec, Utilization Management

Ampcus

Baltimore, MD • On-site

Other

Re-posted 19 days ago

Job description

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team.
Job Title: Spec, Utilization Management
Job Location: Baltimore, MD
Job Description:
Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, concurrent and retrospective reviews for authorization, appropriateness of care determination and benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist will analyze clinical information, contracts, mandates, medical policy, evidence-based published research, national accreditation and regulatory requirements to contribute to determination of appropriateness and authorization of clinical services both medical and behavioral health.
ESSENTIAL FUNCTIONS
  • Abstractor Primary functions:
    • 50% Determines medical necessity and appropriateness by referencing regulatory mandates, contracts, benefit information, Milliman Care Guidelines, Apollo Guidelines, ASAM (American Society of Addiction Medicine), Medicare Guidelines, Federal Employee Program and Policy Guidelines, Medical Policy, and other accepted medical/pharmaceutical references (i.e. FDA, National Comprehensive Cancer Network, Clinical trials.Gov, National Institute of Health, etc.) Follows NCQA Standards, Medical Policy, all guidelines and departmental SOPS to manage their member assignments. Understands all lines of business to include Commercial, FEP, and Medicare primary and secondary policies.
    • 30% Conducts research and analysis of pertinent diseases, treatments and emerging technologies, including high cost/high dollar services to support decisions and recommendations made to the medical directors. Collaborates with medical directors, sales and marketing, contracting, provider and member services to determine appropriate benefit application. Applies sound clinical knowledge and judgment throughout the review process. Coordinates non-par provider/facility case rate negotiations between Provider Contracting, providers and facilities. Follows member contracts to assist with benefit determination.
    • 20% Makes appropriate referrals and contacts as appropriate. Offers assistance to members and providers for alternative settings for care. Researches and presents educational topics related to cases, disease entities, treatment modalities to interdepartmental audiences.
Qualifications
  • Education Level: Bachelor's Degree
  • Education Details: Nursing
  • Experience: 5 years Clinical nursing experience, 2 years Care Management
  • Clinical Utilization Management expertise, regulatory compliance knowledge, experience in Guiding care platform
Licenses/Certifications
  • RN - Registered Nurse - State Licensure And/or Compact State Licensure Upon Hire Req or
  • LPN - Licensed Practical Nurse - State Licensure
  • CNS-Clinical Nurse Specialist Pref
Preferred Qualifications
  • Working knowledge of managed care and health delivery systems.
  • Thorough knowledge of clinical guidelines, medical policies and accreditation and regulatory standards
  • Working knowledge of IT and Medical Management systems, familiarity with web-based software application environment and the ability to confidently use the internet as a resource.
Knowledge, Skills and Abilities (KSAs)
  • Effective written and interpersonal communication skills to engage with members, healthcare professionals, and internal colleagues, Proficient
  • Must have strong assessment skills with the ability to make rapid connection with Member telephonically., Proficient
  • Must be able to work effectively with large amounts of confidential member data and PHI, Expert
  • Must be able to prioritize workload during heavy workload periods, Proficient
  • Ability to multitask, prioritize and maintain a dynamic personal organization system that allows for flexibility, Advanced
  • Proficient in the use of web-based technology and Microsoft Office applications such as Word, Excel and PowerPoint, Proficient
  • Excellent analytical and problem-solving skills to judge appropriateness of member services and treatments on a case by case basis, Proficient

Ampcus is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veterans or individuals with disabilities.
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About Ampcus

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Ampcus Inc. is a ISO 20000, ISO 27000, ISO 9001, CMMI DEV/3 SM and CMMI SVC/3 SM certified global provider of a broad range of Technology and Business consulting services. From strategy to execution, our disciplined yet flexible approach starts and ends with our clients. By listening hard and working harder, client goals become our goals. Their success is our satisfaction. It’s why our clients sleep well at night. We believe that the success of an engagement is determined by strong project management, as well as clear communication and mutual commitment working collaboratively. Our methodology begins with listening to the customer about their needs, then working with their team to gain a clear understanding of the requirements, while providing knowledge transfer of best practices for the organization.

Industry

It services

Company size

1,001 - 5,000 Employees

Headquarters location

Chantilly, VA, US

Year founded

2004

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