Job Description
Job Description
This position requires a dynamic pharmacist to be the expert on clinical issues, collaborating with the Director of Pharmacy and other staff pharmacists. The role involves designing, implementing, maintaining, and measuring pharmacy-related utilization management programs. This includes the development of workflows, criteria, and ensuring URAC accreditation is maintained. The candidate will work within a collaborative culture to enhance pharmacy services.
Responsibilities - Create and maintain clinical criteria for applicable Utilization Management (UM) programs, including developing criteria process flows and physician communication methods.
- Perform highly complex research and analysis, providing recommendations for UM programs and plan design changes.
- Oversee operational workflows and completion of UM reviews, ensuring clinical oversight of the first-level review process.
- Provide clinical support for Pharmacy Technicians and other staff, utilizing reporting tools to create efficiencies.
- Support physician reviewers with necessary information for reviewing non-approvable claims and develop Decision Tree review processes when applicable.
- Ensure URAC accreditation is maintained by working within scope of licensure and according to state and federal laws.
- Measure quality assurance reporting, turnaround time for urgent and non-urgent reviews, and conduct quantitative assessments of UM reviews by program.
Essential Skills - MUST HAVE a Nebraska Pharmacy License
- Pharm.D degree
- Experience with prior authorization processes
- Knowledge of insurance verification and medical billing
- Familiarity with medical terminology
- Proficiency in data entry and retail pharmacy operations
Additional Skills & Qualifications - Certification in pharmacy technician (Cpht) is preferred
- Experience in Medical Therapy Management (MTM) is beneficial
Work Environment This is a 100% remote role with a standard shift from 8am to 5pm, Monday through Friday. There is potential for flexible shifts, which may require availability on weekends in the future. The position offers a unique opportunity to work in a less hectic environment compared to clinical settings, providing a significant career stepping stone.
Job Type & Location This is a Contract position based out of Omaha, Nebraska.
Pay and Benefits
The pay range for this position is $60.00 - $70.00/hr.
Eligibility requirements apply to some benefits and may depend on your job
classification and length of employment. Benefits are subject to change and may be
subject to specific elections, plan, or program terms. If eligible, the benefits
Available For This Temporary Role May Include The Following - Medical, dental & vision
- Critical Illness, Accident, and Hospital
- 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
- Life Insurance (Voluntary Life & AD&D for the employee and dependents)
- Short and long-term disability
- Health Spending Account (HSA)
- Transportation benefits
- Employee Assistance Program
- Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a fully remote position.
Application Deadline
This position is anticipated to close on Oct 20, 2025.
About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.
Job Tags
Contract work, Temporary work, Remote work, Monday to Friday, Flexible hours, Shift work, Weekend work,