Clinical Pharmacist Utilization Management - Remote in PST id-10109

June 3, 2025

Job Description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

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Unique opportunity for a clinical pharmacist to improve patient care and outcomes through completion of utilization management functions for value-based patients in the Optum West region.

This is a full-time position with variable hours between 7:00 am to 6:00 pm PST, Monday - Friday (Five 8-hour days). Rotating weekend coverage. 100% telecommuter position.

Under general supervision of the Pharmacy Manager, the Clinical Pharmacist is responsible for evaluating medication utilization and prior authorization requests for specialty oncology and non-oncology ambulatory injectable and/or infusion medications as related to member benefits, medical necessity, site of service, and evidence based clinical guidelines.

If you are located in the PST time zone, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

Completes assigned daily prior authorization case reviews to meet production and performance metrics as determined by the department to maintain compliant timeliness standards

Review specialty medication prior authorization requests according to established treatment protocols, clinical criteria/guidelines, regulatory requirements and member benefits to ensure consistent and accurate application of clinical criteria & the determination is made within the defined processing times to meet regulatory requirements

Knowledgeable of current and emerging clinical trends

Provide internal and external clinical pharmacy subject matter consultation to members, physicians, prescribers, nurses, and pharmacists

Proactively identify process improvement opportunities and collaborate with other teams and leaders

Assist with user acceptance testing for new clinical programs and system enhancements

Ensure and evaluate quality controls and implement opportunities for performance improvement in pharmacy practice specific to specialty pharmacy

Research and awareness about drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews

Follow all policies and procedures, SOPs related to the job

Performs all other related duties/activities as assigned to meet departmental objectives

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

Doctor of Pharmacy degree (PharmD)

Current unrestricted Pharmacist license to practice in CO, UT, AZ, or WA

Willing to pursue licensure in additional states to include AZ, CA, NM, NV, UT, ID, WA & OR

3+ years of experience as a Prior Authorization Pharmacist or Clinical Pharmacist, conducting such activities as medication therapy management, clinical rounds, disease state management, etc. Relevant experience includes ANY of the following or a combination thereof:

Retail pharmacy

Pharmacy Benefit Management

Infusion or hospital pharmacy experience

Proven excellent written and verbal communication skills

Experience working in a metric-driven environment

Proven excellent relationship building skills

Proven solid analytical and PC operation skills

Preferred Qualifications:

Board certification by the Board of Pharmacy Specialties (BPS)

Certified Geriatric Pharmacist

AZ Unrestricted Pharmacist License

CO Unrestricted Pharmacist License

NM Unrestricted Pharmacist License

NV Unrestricted Pharmacist License

UT Unrestricted Pharmacist License

WA Unrestricted Pharmacist License

OR Unrestricted Pharmacist License

ID Unrestricted Pharmacist License

1+ years of experience in Oncology Setting

Proven knowledge of Medicare, Medicaid, and commercial payor guidelines

Demonstrated planning and organizational skills to demonstrate leadership and initiative

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