You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients. Job Summary Our client is seeking a Pharmacist to perform first-level pharmacy utilization management and prior authorization reviews. This role involves reviewing incoming pharmacy cases to determine whether medication requests meet established clinical and medical policy criteria. The Pharmacist will be responsible for approving or denying medication requests based on established guidelines, processing a high volume of cases daily, and supporting pharmacy clinical initiatives and drug utilization management programs. The focus is specifically on pharmacy benefit reviews, with no peer-to-peer discussions, ensuring efficient review and adherence to criteria.
Key Responsibilities
- Perform first-level pharmacy utilization management and prior authorization reviews.
- Review incoming pharmacy cases to determine whether medications meet established clinical and medical policy criteria.
- Approve or deny medication requests based on established guidelines.
- Process approximately 80–100 cases daily once fully trained.
- Support pharmacy clinical initiatives and drug utilization management programs.
- Research and analyze clinical cases and medication information.
- Apply clinical judgment to ensure appropriate and cost-effective medication utilization.
- Support formulary management and pharmacy prior authorization programs.
- Maintain productivity and turnaround times while managing a high-volume caseload.
- Collaborate with other pharmacists and internal clinical stakeholders as needed.
- Focus on pharmacy benefit reviews, not medical benefit reviews.
- Conduct first-level reviews only; no peer-to-peer discussions.
Qualifications
- Strong clinical knowledge and decision-making abilities.
- Ability to quickly learn and apply clinical guidelines and established criteria.
- Ability to multitask and manage competing priorities.
- Comfortable working in a fast-paced, high-pressure environment.
- Strong organizational and time-management skills.
- Ability to work independently while collaborating with a larger pharmacy team.
- Strong written and verbal communication skills.
- Preferred: Knowledge of NCQA and HEDIS requirements.
Experience
- Minimum 2 years of pharmacist experience OR completion of accredited clinical pharmacy residency training.
- Preferred: Previous prior authorization (PA) experience.
- Preferred: Utilization management (UM) experience.
- Preferred: Managed care pharmacy experience.
- Preferred: Retail pharmacy experience, particularly in a high-volume setting.
- Preferred: Hospital pharmacy experience.
- Preferred: Experience processing high volumes of prescriptions or clinical cases.
- Preferred: Medication Therapy Management (MTM) experience.
- Preferred: Experience with formulary development and drug utilization management.
- Preferred: Experience developing clinical pharmacy programs or medical policies. Skills
- Strong analytical skills.
- Microsoft Office proficiency.
Education
- Active Washington State pharmacist license in good standing (mandatory).
- Active U.S. pharmacist license in good standing.
- Preferred: PharmD, MBA, MHA, MPH, or other advanced degree. Additional Requirements
- Schedule: Monday–Friday, 8:00 AM–5:00 PM PST.
- Hours: 40 hours per week.
- Start Date: ASAP.
- Location: 100% remote; no onsite requirements.
- Candidate provides their own equipment; dual monitors recommended.
- Must work Pacific Time hours regardless of residential location.
Benefits
- Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
- Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
- 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
- Short Term Disability Insurance.
- Term Life Insurance Plan. *We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
Medix Overview:
With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours. Any required state or Joint Commission training is compensated at the state or local minimum wage rate. *As a job position within our Allied division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: providing direct patient care, accessing medical and confidential records, accessing and administering prescription medication or other drugs, working within a clinical setting, handling sharp instruments, conducting medical procedures, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
