Clinical UM Pharmacist
Healthfirst · United States · US
Utilization Review
Remote
Pharmacist
Dentist
Demand74
Career growth70
Healthcare fit82
Remote potential50
Salary band
USD 89k – 149k
5-year outlook
Managed care and UM pharmacist roles typically offer stable, competitive compensation with room to move into senior UM, formulary, or medical policy leadership. Growth depends on payer hiring cycles and managed care experience; PGY1 managed care residency strengthens long-term positioning.
Clinical license
Required
Applicant reach
narrow
Seniority
mid
Employment type
full-time
Date found
2026-10-03
Intelligence details
Flexible work details
- Engagement type
- Permanent
- Hours
- Full-time
- Eligible countries
- United States
- License jurisdiction
- US
- Profession fit
- Pharmacist, Dentist
- Rate period
- Annual
Listing via Himalayas.
Eligibility, licensing, and location restrictions can change. Always confirm details on the source posting before applying.
Why this is worth applying to
Worth applying for pharmacists with a New York license and prior authorization or managed care exposure who want to transition into payer-side utilization management. Those without NY licensure or PA review experience will likely be screened out early.
Who should apply
New York-licensed pharmacists with at least one year of prior authorization or managed care experience, PGY1 managed care residents, and clinical pharmacists seeking a non-clinical payer pathway in utilization management, medical policy, or drug utilization review.
CV angle
Reframe clinical pharmacy experience around coverage determination, clinical criteria application, drug information research, and regulatory compliance. Highlight any prior authorization, formulary, DUR, or payer interaction work, quantify review volumes or turnaround performance, and emphasize CMS/NYSDOH familiarity, clinical writing, and cross-department collaboration.
Skills to highlight
- Prior authorization review
- Drug utilization review (DUR)
- Clinical criteria and medical policy development
- CMS and NYSDOH regulatory compliance
- Specialty pharmaceutical and billing knowledge
- Clinical writing and presentation
- Microsoft Excel (Pivot tables) and PowerPoint
- Cross-functional collaboration
Role summary
A payer-side utilization management pharmacist role at Healthfirst reviewing prior authorization requests, calculating billable units, developing clinical criteria and medical policies, conducting drug utilization reviews, and ensuring CMS/NYSDOH compliance for medical benefit medications.
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