Specialty UM Pharmacist

About Curative

Curative is building the future of health insurance with a first-of-its-kind employer-based plan designed to remove financial barriers and make care truly accessible: one monthly premium with $0 copays and $0 deductibles*. Backed by our recent $150M in Series B funding and valuation at $1.275B, Curative is scaling rapidly and investing in AI-powered service, deeper member engagement, and a smart network designed for today’s workforce.

 

Our north star guides everything we do: healthcare only works when people can actually use it. That belief drives every decision we make: from how we design our plan, support our members, to how we collaborate as a team.

 

If you want to do meaningful work with a team that moves fast, experiments boldly, and cares deeply, Curative is the place to do it. We’re growing fast and looking for teammates who want to help transform health insurance for the better.

 

 

SUMMARY

 

This role is primarily responsible for utilization management activities related to specialty medications covered under the medical benefit, including provider-administered drugs billed under J-codes, Q-codes, and other HCPCS codes. The pharmacist will perform prior authorization reviews to ensure appropriate, evidence-based use of high-cost specialty therapies. The role will also support medical drug policy development, utilization management strategy, provider education, formulary management, Pharmacy & Therapeutics (P&T) Committee activities, and cross-functional initiatives involving both medical and pharmacy benefits.

As Curative continues to grow, responsibilities may evolve to support organizational and business needs. This is a REMOTE Position with RPh Licensure required in the state of residence.

 

 

ESSENTIAL DUTIES AND RESPONSIBILITIES

 

Performs prior authorization reviews and coverage determinations for medications covered under the medical benefit, including provider-administered therapies billed through J-codes, Q-codes, and other HCPCS codes

Evaluates medical necessity, site-of-care appropriateness, dosing, diagnosis, and adherence to evidence- based clinical criteria for specialty drug requests

Manages all levels of clinical review from Adverse Determination, Appeals and IRO

Supports and manages utilization management operations across medical and pharmacy benefits to ensure alignment with health plan goals

Writes, reviews, and updates PA guidelines to support both pharmacy and medical benefit strategies

Acts as a clinical resource and liaison between medical and pharmacy teams, providing training and education to internal and external stakeholders as needed

Meets assigned metrics and TAT as defined by regulatory requirements within state or lines of business

Collaborate with Medical Directors and other interdepartmental staff to communicate utilization management strategies and clinical programs or initiatives

Reviews and resolves complaints made by members and providers regarding Prior Authorizations

Participates in support of the Pharmacy and Therapeutics Meeting to review and keep current on the drug formulary

Performs appropriate literature and clinical research

Knowledge of utilizing LexiComp, Micromedex, UpToDate, National guidelines, NCCN, etc.

Collaborate to create clear communication to members and/or providers on prior authorization determinations

Supports cross-functional collaboration efforts to bridge pharmacy and medical benefit operations, ensuring seamless integration and clinical alignment

Work in partnership with utilization management staff to assist in the implementation of utilization management programs

Works in collaboration with Pharmacy UM Director to help with workflows and operational efficiencies

Evaluate opportunities for operational or process improvements

Support and manage other related health plan operations

Work adhering to US regulatory and Quality System requirements (21 CFR 820, etc.).

This position assumes and performs other duties as assigned.

Work hours are Monday-Friday and some Saturdays.

 

QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:

Possess strong analytical skills and detail oriented

Ability to work independently with minimal supervision

Understanding of claims processing and claims edits

Intermediate level proficiency with MS Office applications- Word, Power Point, Excel, and Access

Intermediate to advanced pharmacy drug recognition

Ability to work in a dynamic and fast-paced environment

Required

2 years of experience with specialty medications or prior authorization

1 year of experience with PBM or Managed Care setting

Preferred Qualifications

3 years as practicing pharmacist or 1 year as PGY-1 resident

2 years experience in a Managed Care Setting

Knowledge of Medispan or First Data Bank and drug classification system

BCPS or CSP certification

Experience with medical drug policies, utilization management programs, or health plan operations

Experience reviewing oncology, immunology, rheumatology, gastroenterology, neurology, or other specialty medications

Knowledge of HCPCS coding, medical claims adjudication, and specialty drug reimbursement methodologies

 

EDUCATION and/or EXPERIENCE

Doctor of Pharmacy (Pharm D) degree.

 

CERTIFICATES, LICENSES, REGISTRATIONS

Must possess an active RPh license within state of residence.

 

WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit; use hands to handle or feel; talk; and hear.

For this position the percentage of expected Travel is: 0%-10%% of the time

 

 

Perks & Benefits 

 

Curative Health Plan (100% employer-covered medical premiums for you and 50% coverage for dependents on the base plan.)

$0 copays and $0 deductibles (with completion of our Baseline Visit )

Preventive and primary care built in

Mental health support (Rula, Televero, Two Chairs, Recovery Unplugged)

One-on-one care navigation

Chronic condition programs (diabetes, weight, hypertension)

Maternity and family planning support

24/7/365 Curative Telehealth

Pharmacy benefits 

Comprehensive dental and vision coverage

Employer-provided life and disability coverage with additional supplemental options

Flexible spending accounts 

Flexible work options: remote and in-person opportunities 

Generous PTO policy plus 11 paid annual company holidays

401K for full-time employees

Generous Up to 8–12 weeks paid parental leave, based on role eligibility.