Highmark · 1 hour ago
Pharmacist - Utilization Management (UM) - Remote
United States
Full-time
Remote
Entry Level
$68K/yr - $126K/yr
1+ years expHighmark Inc. is a healthcare company seeking a Pharmacist for Utilization Management. The role involves reviewing medication coverage requests for prior authorization and appeals, evaluating clinical information against medical policy criteria, and making coverage determinations based on clinical knowledge and research.
Health CareHealth InsuranceInsuranceWellness
Responsibilities
Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure claims are properly routed and paid
Conduct research beyond medical policy review to make decisions on medication coverage requests
Other duties as assigned
Qualification
Required
Bachelor's degree in Pharmacy
1 - 3 years in Pharmacy
Registered Pharmacist
Oral & Written Communication Skills
General Computer Skills
Problem Solving & Decision Making
Compliance
Prioritizing
Preferred
Doctorate degree in Pharmacy
Company
Highmark
Highmark provides health insurance plans for individuals and businesses.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$27.3M2018-04-06Grant· $25M
2014-08-07Grant· $2.3M
Leadership Team
Deborah Rice-Johnson
CEO, Diversified Businesses at Highmark Inc. and Chief Growth Officer
Paul Sikora
CTO Provider Services
Recent News
2025-12-11
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