Job at a glance
Job Title: Remote Clinical Pharmacist – Commercial Utilization Management Job Description This remote Clinical Pharmacist role focuses on reviewing Commercial members’ Utilization Management requests, including formulary exceptions, prior authorizations, step therapy, and quantity limit exceptions. You will apply clinical judgment to evaluate coverage determinations using client-specific criteria, document clear decisions, and communicate effectively with healthcare providers and team members.
The position offers an opportunity to move away from retail pharmacy, work independently in a structured environment, and potentially expand into specialized case review and other clinical programs over time. Responsibilities Review and complete Commercial Utilization Management requests such as prior authorizations, formulary exceptions, step therapy, quantity limit exceptions, and tier exceptions with a high level of accuracy and attention to detail.
Evaluate coverage determination requests using client-specific, pre-approved clinical criteria, ensuring that approval or denial decisions align with the clinical content of each case and the intent of the criteria. Draft and apply appropriate denial language that accurately reflects the clinical reasoning and supports clear, compliant communication to members and prescribers. Use sound clinical judgment to assess complex medication regimens and therapy plans, making independent decisions while leveraging available resources and guidelines.
Provide direct consultation to healthcare providers and members regarding non-formulary medications and other clinical product coverage issues, offering clear and professional explanations. Collaborate closely with other pharmacists, supervisors, technicians, and team members to promote consistency of decisions and maintain alignment on clinical standards across the pharmacist team. Participate in routine touchpoints, including training sessions, team meetings, and one-on-one discussions via video calls and messaging platforms, to stay informed and engaged with team goals.
Meet established productivity expectations by completing cases efficiently and maintaining throughput consistent with team averages. Maintain a quality score of at least 95% by ensuring decisions and documentation are accurate, complete, and compliant with policies and clinical criteria. Demonstrate strong accountability through reliable attendance, timely communication, and adherence to scheduling and overtime requirements, especially during peak season.
Adapt to feedback from supervisors and senior pharmacists, continuously improving clinical decision-making, problem-solving, and workflow efficiency. Quickly learn and effectively use multiple computer systems, platforms, and tools, including Microsoft Word, Excel, AutoHotkey, and multi-monitor setups, to manage and process cases. Participate in training programs that include instructor-led sessions, videos, worksheets, and practice cases, and apply learned concepts to production work.
Maintain flexibility to take on additional responsibilities as assigned, which may include cross-training for specialized case review (such as oncology or hepatitis C) or other departments like Medication Therapy Management or Call Center Counseling, as business needs allow. Support a positive team culture by being receptive to feedback, demonstrating learning agility, and contributing to a collaborative, team-oriented environment.
Essential Skills Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy degree. Current pharmacist license in good standing with a State Board of Pharmacy in the state where the position is located or as required, with full transparency regarding any disciplinary actions on the license. Current active Tennessee pharmacist license in good standing. Entry-level, will consider all levels of experience.
Demonstrated ability to make independent clinical decisions and apply clinical judgment to complex medication and cove