Licensed Utilization Management Pharmacist

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