Licensed Utilization Management PharmacistVirtualVocations • Hollywood, Florida, United States
Licensed Utilization Management Pharmacist
VirtualVocations • Hollywood, Florida, United States
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A company is looking for a Utilization Management (UM) Pharmacist Reviewer to lead the clinical validation and translation of payer policies into AI-powered prior authorization workflows.
Key Responsibilities
Translate payer and evidence-based policies into structured clinical decision logic
Validate and approve AI-generated prior authorization recommendations for medications and biologics
Partner with cross-functional teams to define requirements and guide the design of clinical decision trees
Required Qualifications
Licensed Pharmacist (PharmD or RPh) in good standing
3+ years of experience in pharmacy utilization management or medical policy review
Proven ability to lead clinical policy translation and review workflows
Strong understanding of specialty and biologic drug reviews
Experience interpreting payer drug policies and clinical criteria
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