• Pharmacist , Utilization…

    Molina Healthcare (Vancouver, WA)
    … (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management ), clinical pharmacy ... patient outcomes, medications safety and medication use policies). **KNOWLEDGE/SKILLS/ABILITIES** The Pharmacist , UM will be responsible for reviewing coverage… more
    Molina Healthcare (07/27/25)
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  • Pharmacy Operations Clinical Pharmacist…

    Blue Cross Blue Shield of Massachusetts (Hingham, MA)
    …transform healthcare? Bring your true colors to blue. The Pharmacy Operations Clinical Pharmacist Manager manages and directs clinical staff in the day to day ... clinical operational UM activities to ensure that all Commercial (Pharmacy and...development, and implementation of new Clinical Pharmacy and Drug Utilization initiatives to ensure quality, affordable care. + Collaborate… more
    Blue Cross Blue Shield of Massachusetts (06/26/25)
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  • Fully Remote PA Review Pharmacist

    Actalent (Eagan, MN)
    …your primary responsibility will be leveraging your clinical skills to complete utilization management ( UM ) reviews-including prior authorizations, coverage ... Now Hiring: Pharmacist - 100% Remote | $55/hr | Consultant-to-Hire...Join a dynamic team where your expertise powers critical utilization management decisions that directly affect patient… more
    Actalent (07/23/25)
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  • Pharmacist - Clinical Advisor

    CVS Health (Jefferson City, MO)
    …o Consulting with and recommending standard and custom formulary options and utilization management edits. o Collaborating with internal partners to develop ... drives lowest net cost. o Consulting with and recommending utilization management programs or other clinical programs...Advisor will consult with and advise the Clinical Benefits Pharmacist , and or other members of the Benefits and… more
    CVS Health (07/29/25)
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  • Manager Clinical Pharmacy Operations (Remote)

    Highmark Health (Harrisburg, PA)
    …managing or supervising clinicians (such as pharmacists, nurses, or other clinicians) in a utilization management operations setting in a PBM or Health Plan. + ... clinical pharmacy strategies and other pharmacy strategy teams to execute on the formulary/ utilization ( UM ) and other strategic pharmacy products. This job will… more
    Highmark Health (06/26/25)
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  • Case Manager, RN or Licensed Behavioral Health (SN…

    Excellus BlueCross BlueShield (Rochester, NY)
    …of consistent and quality health care services. Examples may include: Utilization Management , Quality, Behavioral Health, Pharmacy, Registered Dietitian and ... within the group. + Responsible for all aspects of the Case Management department functions including quality, productivity, utilization performance, and… more
    Excellus BlueCross BlueShield (06/27/25)
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  • Clinical Pharmacy Technician I- Prior…

    Highmark Health (Wexford, PA)
    …with all regulatory agency requirements **ESSENTIAL RESPONSIBILITIES** + Reviews pharmacy utilization management ( UM ) coverage requests and prepares ... such cases for clinical review by a pharmacist and/or medical director when required. (20%) + Within...+ May perform other non-clinical duties as required by management and department needs. **QUALIFICATIONS** **Required** + 2 years… more
    Highmark Health (06/26/25)
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