Pharmacy Utilization Management Specialist

Point32Health

. Set up and process drug prior authorization requests received by fax, ePA, phone, and email .

Posted 10/22/2026full-timeRemote • Massachusetts • United StatesJuniorMid-Level💰 $24 - $37 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in processing drug prior authorization requests and ensuring compliance with regulatory and accreditation standards. Proficient in managing high volumes of requests while maintaining accuracy and effective communication with providers and team members.

Highest-signal resume keywords

Certified Pharmacy Technician (CPhT)Pharmacy ExperienceManaged Care/PBM ExperienceRxClaims Software ExperienceMS Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Drug Prior Authorization ProcessingCase ReviewQuality Checks for ComplianceMedical Terminology KnowledgeHigh Volume Request Processing

Soft Skills

Judgment and Decision-MakingTeam CollaborationIndependent Work AbilityEffective Communication

Tools & Technologies

PAHub SoftwareMS ExcelMS WordMS PowerPoint

Certifications & Qualifications

Certified Pharmacy Technician (CPhT)

Industry Keywords

HealthcarePharmacy Benefit Manager (PBM)Regulatory ComplianceAccreditation Standards

About the role

Key responsibilities & impact

Set up and process drug prior authorization requests received by fax, ePA, phone, and email
Perform full case reviews and ensure regulatory, accreditation, and turnaround-time requirements are met
Document relevant case notes for prior authorizations requiring pharmacist or medical director review
Run test claims for approved authorizations
Contact members and providers as necessary
Communicate with providers through the department phone queue and resolve provider inquiries
Perform daily quality checks for compliance
Manage the Pharmacy UM team email box
Manage electronic prior authorization requests
Submit process improvements
Perform other assigned roles, duties, and projects

Requirements

What you’ll need

Certified Pharmacy Technician (CPhT)
High School Diploma or GED required
Associate's degree in Healthcare, Nursing, or a related area or equivalent experience
2 years of pharmacy experience required
Experience in managed care/PBM setting preferred
Software/database experience with RxClaims and PAHub preferred
Proficient in MS Office—Excel, Word, and PowerPoint preferred
Ability to prioritize medical and pharmacy drug PA requests according to guidelines and turnaround times
Ability to process high volumes of requests accurately
Working knowledge of medical terminology
Ability to work independently and as part of a team
Ability to exercise appropriate judgment while following rules and regulations
Must be able to work under normal office conditions and work from home as required
Must be able to use a telephone/headset and PC/keyboard simultaneously and sit for extended durations
Flexibility to work additional hours, including early mornings, evenings, weekends, or extended workdays as required

Benefits

Comp & perks

Medical, dental and vision coverage
Retirement plans
Paid time off
Employer-paid life and disability insurance with additional buy-up coverage options
Tuition program
Well-being benefits
Full suite of benefits to support career development, individual & family health, and financial health
Variable pay eligibility