Utilization Management Pharmacist Jobs in Pittsburgh, PA

Join a dynamic team as a Medical Claims Auditor, ensuring compliance and integrity in healthcare payments. Collaborate with cross-functional teams to identify fraud, waste, and abuse while leveraging...

Lead transformative process improvements to enhance healthcare quality and efficiency. Collaborate with teams to elevate performance metrics, oversee cultural competency initiatives, and drive strateg...

Grow your career with a dynamic team focused on optimizing provider operations. Lead credentialing initiatives, implement AI solutions, and enhance workflows while ensuring compliance and operational...

Elevate patient care by providing after-hours clinical support, triaging needs, and coordinating with interdisciplinary teams to ensure quality outcomes and continuity of care in hospice settings...

Champion quality performance initiatives by collaborating across departments to enhance healthcare outcomes through data analysis, project management, and compliance with regulatory standards, ensurin...

Unlock innovative healthcare solutions by leading product strategy and lifecycle management for clinical programs. Collaborate across teams to enhance member experiences and drive business value while...

Lead the charge in developing and executing drug formulary strategies, ensuring compliance with regulations while collaborating with cross-functional teams to enhance pharmacy utilization management a...

Empower holistic patient care while leading pharmacy operations and education initiatives. Guide clinical practice and ensure the safe use of medications in a dynamic healthcare environment with a foc...

Lead the sales strategy for a healthcare Payer business unit, driving market penetration, revenue growth, and client satisfaction. Collaborate with leadership to shape go-to-market strategies and buil...

Unlock member value by managing pharmacy solutions, optimizing contract use, and fostering relationships with healthcare systems to enhance operational efficiency and savings...

Drive accurate, evidence-based clinical claims while collaborating with Marketing, Legal, and Clinical teams. Build and manage the claims framework and evidence library to support bold, compliant mark...

Shape the future of managed care by leading contract negotiations, performance monitoring, and strategic initiatives to optimize reimbursement and enhance payer relationships across healthcare service...

Drive the advancement of a comprehensive privacy strategy, ensuring compliance with regulations and fostering a culture of data protection across the organization. Lead risk assessments, training, and...

Shape pharmacy services by overseeing drug therapy, resolving issues, and ensuring compliance. Collaborate with healthcare teams to enhance patient outcomes through effective medication management and...

Join a team that's driving strategic leadership in contract negotiations and operational support across diverse healthcare services. This role focuses on enhancing market share and reimbursement initi...

Optimize compliance and revenue management across healthcare facilities, ensuring adherence to state and federal reimbursement regulations while enhancing financial performance through strategic analy...

Lead the charge in managing the Financial Investigations & Provider Review department, focusing on pharmaceutical fraud detection and recovery. Guide a team of investigators to enhance compliance and...

Contribute to exceptional patient care as a Pharmacist in our Specialty Mail Service Pharmacy, providing leadership, drug therapy monitoring, and patient education while ensuring accurate pharmaceutic...

Join a team that's dedicated to enhancing patient care as a Pharmacist in our Specialty Mail Service Pharmacy. You'll provide exceptional service, lead staff, and ensure accurate pharmaceutical care w...

Develop and lead comprehensive benefits and compensation programs, ensuring alignment with business goals and enhancing employee experience through strategic management and continuous improvement init...

Join a dynamic team to evaluate and process medication prior authorization requests, ensuring compliance with clinical guidelines and regulatory standards while facilitating timely patient access to n...

Engage with healthcare providers to enhance patient access in long-term care settings. Serve as a trusted liaison, addressing access-related challenges and ensuring timely treatment through collaborat...

Lead the charge in driving operational excellence and strategic direction for a high-performing underwriting team, ensuring quality Medicare underwriting services that support profitable growth and bu...

Empower our channel partner division by managing operational activities, coordinating RFPs, and driving cross-functional collaboration to enhance sales and partner engagement. Your insights will shape...

Unlock potential by leading strategic government programs, managing P&L, and driving operational excellence. Oversee contract delivery, mentor staff, and foster client relationships to ensure growth a...