REMOTE Prior Authorization Pharmacist

The Clinical Care Pharmacist plays a vital role in ensuring safe, effective, and appropriate medication use. This position is responsible for reviewing prior authorization requests, supporting clinical programs, and providing expert guidance to members, providers, and pharmacies. The role requires a strong clinical background, sound decision-making, and a commitment to service excellence in a fast-paced, collaborative environment.

Location: Remote

• 7a-4p EST
• 9a-6p EST
• 11a-8p EST
• 2p-11p EST

• Base pay range: $/yr - $/yr
• Salary Range: $120,000 – $125,000 annually
• Potential consideration: up to $127,500 for exceptional candidates
• Employment Type: Full-Time, Salaried (40 hours/week)

• Review and make timely, evidence-based decisions on prior authorizations, appeals, and override requests in alignment with clinical guidelines and benefit criteria.
• Ensure compliance with federal, state, and internal regulations across Commercial, Exchange, Medicare, and Medicaid plans.
• Accurately document all clinical decisions and maintain records in accordance with URAC/NCQA utilization review standards.
• Provide empathetic and professional support to members, prescribers, and pharmacies via phone.
• Stay current with prescribing guidelines, policies, and regulatory changes, applying them to daily responsibilities.
• Follow HIPAA and internal procedures to safeguard patient privacy and data security.
• Identify and report potential fraud, waste, and abuse.
• Assist with training and mentoring new and existing team members as needed.
• Support leadership with special projects, process improvements, and operational initiatives.

• Bachelor’s or Doctor of Pharmacy degree.
• Minimum of 2 years of pharmacy practice experience.
• Experience in managed care or pharmacy benefit management (PBM).
• Strong communication, writing, and organizational skills.
• Ability to manage multiple priorities in a high-volume, metric-driven environment.
• Availability to work after hours, weekends, and holidays on a rotating schedule.

• Call center or telephonic clinical support experience.

• Salaried role (40 hours/week)
• Salary range: $120,000 – $125,000 annually, with potential consideration up to $127,500 for exceptional candidates.
• Competitive benefits package provided.

This role supports a rapidly expanding clinical team in preparation for new client implementations. Start dates are planned for October and November, with full training provided.