Pharmacy Utilization Management Specialist

Point32Health

. Set up and process drug prior authorization cases received by fax, electronic prior authorization, 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 managing drug prior authorization processes, ensuring compliance with regulatory and accreditation standards while effectively communicating with providers and members. Proficient in utilizing pharmacy management software and maintaining high accuracy in processing requests.

Highest-signal resume keywords

Certified Pharmacy Technician (CPhT)Pharmacy ExperienceRxClaims Software ExperiencePAHub Software ExperienceMedical Terminology Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Drug Prior Authorization ProcessingQuality Checks for ComplianceCase DocumentationHigh Volume Request ProcessingRegulatory Compliance

Soft Skills

Judgment and Decision-MakingTeam CollaborationIndependent WorkCommunication SkillsFlexibility

Tools & Technologies

MS OfficeExcelWordPowerPointPharmacy Utilization Management Software

Certifications & Qualifications

Certified Pharmacy Technician (CPhT)

Industry Keywords

Managed CarePharmacy Benefit Manager (PBM)HealthcareAccreditation StandardsTurnaround Time Requirements

About the role

Key responsibilities & impact

Set up and process drug prior authorization cases received by fax, electronic prior authorization, phone, and email
Review cases to ensure regulatory, accreditation, and turnaround-time requirements are met
Document 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 Utilization Management team email inbox
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
Associate's degree in Healthcare, Nursing, or a related area or equivalent experience
Minimum 2 years of pharmacy experience
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 prior authorization requests according to guidelines and turnaround times
Ability to process high volumes of requests accurately
Good 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
Ability to work under normal office conditions and from home as required
Ability to work extended hours, including early mornings, evenings, weekends, or extended workdays as required
Flexibility with work schedule

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