Job Description

Job Description

Job Description

• Pay: $52.07 - $53.00 per hour

  Job description:

  Job Posting: Prior Authorization Pharmacist (Remote – U.S.)
  Pay Rate: $53/hr

  Position Summary

  We are seeking a Licensed Pharmacist with PBM or Prior Authorization experience to join the Clinical Commercial Prior Authorization & Case Review Unit (CRU) . This is a safety-sensitive, remote role requiring strong clinical judgment, attention to detail, and the ability to handle inbound calls from physicians and members regarding pending, approved, or denied prior authorizations.

  Location & Work Requirements

• Fully remote – anywhere in the continental U.S.
• Exclusions: Candidates residing in New Mexico or Colorado are not eligible
• Broadband internet & smartphone required
• Minimum internet speed: 25 Mbps download / 3 Mbps upload
• Must submit screenshot of speed test ( and pharmacist license at the top of resume
• Private, secure home workspace required
• Must comply with Teleworker Privacy & Security Practices (equipment security, locked workstations, confidential workspace, etc.)
• Candidate must have stable living accommodations and acknowledge that the assignment may convert to in-office if required

• Schedule

• Training: Mon–Fri, 8:00am–4:30pm CT (7 weeks)
• Production shifts (Sun–Thurs or Tues–Sat):
• 10:30am–7:00pm CST
• 11:00am–7:30pm CST
• 11:30am–8:00pm CST
• Mandatory overtime/extended work weeks may be required during peak season

• Key Responsibilities

• Clinical Review (60%) – Evaluate prior authorization requests, verify coverage, apply clinical criteria, and communicate determinations to providers, health plans, and members.
• Collaboration (25%) – Work with technicians and PA team members to process referrals, answer clinical questions, and manage escalations.
• Professional Knowledge (10%) – Maintain up-to-date knowledge of drug and disease states within Specialty & Non-Specialty Pharmacy programs.
• Additional Duties (5%) – Participate in training, development sessions, and provide on-call after-hours pharmacist support as needed.

• Essential Functions

• Regular and predictable attendance
• Compliance with company, state, and federal requirements
• Participation in ongoing training and meetings
• Effective multitasking across multiple systems
• Mentorship for non-clinical PA team staff

• Qualifications

  Education:

• Required: BS Pharmacy and active Registered Pharmacist license (state of residence/practice)
• Preferred: PharmD

• Experience:

• Required: 1–3 years
• Preferred: 3–5 years
• Prior authorization pharmacist experience required (PBM or Prior Auth background a must)

• Skills:

• Proficiency in Microsoft Office Suite (Excel & Word required; Access, Outlook, PowerPoint, Visio preferred)
• Strong multitasking, problem-solving, and detail orientation
• Excellent verbal, written, and listening communication skills
• Ability to handle confidential PHI securely
• Must adapt to changing priorities and workflows

• Work Environment & Physical Requirements

• Remote, climate-controlled, smoke-free environment
• Extended periods of sitting, phone/computer use, and screen time (100%)
• Occasional light lifting (<10 lbs)

• INDJP

  Job Type: Full-time

  Work Location: Remote

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