Utilization Management Pharmacist

Position Summary:

• The Utilization Management Pharmacist promotes safe, effective, and appropriate medication use.
• This role reviews prior authorization requests, supports clinical programs, and provides expert guidance to members, providers, and pharmacies.

Responsibilities:

• Make timely, evidence-based decisions on prior authorizations, appeals, and override requests.
• Accurately document clinical decisions and maintain records in accordance with regulatory and accreditation standards.
• Identify and report potential fraud, waste, and abuse, and support training of team members as needed.

Qualifications:

• Active, unrestricted pharmacist license and a Bachelor's or Doctor of Pharmacy degree.
• Minimum of 6 months to a year of prior authorization or utilization management experience.
• Strong communication, organizational skills, and ability to manage multiple priorities in a metric-driven environment.

About Judi Health:

• Judi Health replaces fragmented systems with a Unified Claims Processing™ architecture.
• The company delivers true price transparency and AI-powered care delivery to achieve operational efficiency.