Clinical Pharmacist - Utilization Management (PBM)

Location: Remote; core operating hours are weekdays between 8 am and 8 pm Eastern Time.

Base salary: $120,000–$125,000 annually. Compensation is determined by geographic location, experience, and qualifications.

Company

hirify.global is a healthcare company developing a modern mobile platform and pharmacy benefit management model that helps patients access appropriate care and medications while helping clients manage pharmacy spend.

What you will do

• Review utilization management requests for clinically appropriate and cost-effective coverage decisions across lines of business.
• Ensure cases are handled according to state and federal guidelines, including turnaround-time requirements.
• Coordinate utilization management activities with pharmacy technicians, pharmacists, medical directors, and the Pharmacy Navigation team.
• Discuss clinical strategy and decision rationale with prescribers when needed.
• Support quality review, inter-rater reliability, and Pharmacy & Therapeutics processes.
• Research and develop clinical policies and programs for prior authorization, step therapy, quantity limits, and coverage determinations.

Requirements

• Required pharmacy degree; PharmD preferred.
• At least one year of experience coordinating medication selection with prescribers and care teams.
• Pharmacist license in good standing in the state of residence, with willingness to obtain and maintain licenses in multiple states as needed.
• Preferred: 1–3 or more years of managed care, PBM, health plan, or prior authorization experience.
• Ability to work 40 hours per week during the stated Eastern Time operating hours, with potential evening or weekend shifts and approximately one on-call period every two months.
• Strong pharmacy benefit knowledge, communication, prioritization, problem-solving, project leadership, and influencing skills.

Culture & Benefits

• Remote work arrangement with weekday operating hours aligned to Eastern Time.
• Work focused on fairness, transparency, supply-chain access, physician-patient relationships, and consumer navigation.
• Values include being human first, redefining what is possible, debating then committing, cultivating grit, and seeking to delight.
• Inclusive equal opportunity environment that values diverse perspectives, backgrounds, and education.