Pharmacist - Utilization Management (UM) - Remote

Location: Remote work from Pennsylvania, United States

Company

hirify.global provides health insurance and related healthcare services.

What you will do

• Review physician requests for medication coverage, prior authorizations, and appeals.
• Evaluate clinical information against medical policy criteria using the Utilization Review system.
• Make coverage determinations based on clinical knowledge, policy requirements, and submitted documentation.
• Conduct additional research for medication coverage requests when needed.
• Update system records to ensure claims are properly routed and paid.

Requirements

• Bachelor's degree in Pharmacy.
• 1–3 years of pharmacy experience.
• Registered Pharmacist license.
• Strong oral and written communication skills.
• General computer skills, problem-solving and decision-making abilities, prioritization, and compliance awareness.

Culture & Benefits

• Remote, work-from-home position.
• Position follows applicable legal, ethical, compliance, privacy, and information-security requirements.
• Responsibilities include protecting confidential customer information and complying with HIPAA and company privacy policies.