Specialty Pharmacist; Remote, CTH, PBM

This fully remote Clinical Pharmacist role focuses on utilization management for specialty medications, with a strong emphasis on oncology and other complex therapeutic areas. You will perform detailed clinical reviews of coverage determination requests, including prior authorizations, formulary exceptions, step therapy, and quantity limit exceptions across Commercial, Medicare (non-claims), and Medicaid lines of business. The position offers an opportunity to transition away from retail pharmacy into a highly clinical, data-driven environment, with the potential for long-term conversion to a permanent role and a comprehensive benefits and vacation package after conversion.

• Review and complete clinical evaluations for coverage determination requests related to prior authorization and other utilization management programs, including formulary exceptions, step therapy, and quantity limit exceptions.

• Assess specialty medications, primarily injectables and infused therapies, across oncology (approximately 60%) and other specialties such as rheumatology, gastroenterology, neurology, and dermatology.

• Apply client-specific clinical criteria and evidence-based guidelines to determine whether prior authorization requests meet coverage requirements.

• Exercise sound clinical judgment when evaluating complex and often uncommon or cutting‑edge therapies spanning approximately 500 specialty medications.

• Document clinical rationales clearly and accurately in the appropriate systems to support coverage determinations and downstream processes.

• Consult directly with health care providers via inbound and outbound calls to discuss non-formulary and clinical product coverage issues and clarify clinical information when needed.

• Collaborate with fellow pharmacists, senior pharmacists, technicians, and other team members to promote consistency in clinical decisions and adherence to established criteria.

• Engage in regular communication with supervisors and team members through messaging platforms, phone calls, and video meetings for training, team meetings, and one-on-one discussions.

• Utilize multiple computer systems and platforms simultaneously, including Microsoft applications and Auto Hotkey, to manage cases efficiently and accurately.

• Maintain productivity by completing an average of approximately 30 cases per day while upholding high standards of accuracy and clinical quality.

• Demonstrate strong attendance, accountability, and professional communication in all interactions with internal and external stakeholders.

• Adapt to feedback, process changes, and evolving clinical criteria while maintaining focus, problem‑solving skills, and learning agility.

• Work independently in a remote environment while actively contributing to a collaborative, team‑oriented culture.

• Participate in extensive initial training, including instructor‑led sessions, videos, worksheets, and practice case reviews, and begin handling live cases by the third or fourth week of training.

• Perform other related duties as assigned to support the overall goals of the utilization management team.

• Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy degree.

• Current pharmacist license in good standing with a U.S. State Board of Pharmacy in the state where the candidate is licensed.

• Five (5) or more years of work experience as a pharmacist in retail, managed care, or clinical pharmacy settings

This is a Contract position based out of Seattle, WA.

The pay range for this position is $55.00 - $55.00/hr.

Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job…