Pharmacist, Healthcare

Actively Screening for multiple Remote - Pharmacists to join leading pharmacy benefits optimizer based out of Birmingham, AL!

The Clinical Pharmacist supports the review of prior authorization and appeal requests by evaluating clinical documentation and making coverage determinations based on established criteria. This role involves collaborating with prescribers, pharmacies, and internal teams to obtain necessary clinical information, document decisions, and communicate outcomes. The pharmacist ensures reviews are completed accurately, efficiently, and in compliance with applicable regulatory and client requirements while contributing to process improvements within the prior authorization program.

• Evaluate clinical documentation to make coverage determinations.
• Collaborate with prescribers, pharmacies, and internal teams to gather necessary clinical information.
• Document decisions and communicate outcomes effectively.
• Ensure reviews are completed accurately and efficiently in compliance with regulatory requirements.
• Contribute to process improvements within the prior authorization program.

• Active pharmacist license in the state of residence (PharmD required).
• Prior experience with prior authorization review.
• Ability to work efficiently in a production-driven environment while managing multiple high-priority tasks and deadlines.
• Strong attention to detail with a commitment to accuracy and quality.
• Excellent verbal, written, organizational, and interpersonal communication skills.

• Experience with multiple PBM platforms and payer-specific prior authorization workflows.
• Familiarity with medical benefit vs. pharmacy benefit coverage determinations.
• Exposure to appeals processing (first-level, second-level, or external review submissions).
• Working knowledge of managed care, utilization management, or health plan operations.
• Comfort reviewing specialty medications (e.g., biologics, oncology, immunology, rare disease).
• Understanding of CMS, state-level, and payer regulatory requirements related to prior authorization.
• Experience using workflow, ticketing, or case management systems for clinical reviews.

This is a 100% work-from-home position. The work involves regular use of a computer keyboard, mouse, and calculator. The majority of the workday is spent seated at a desk, with the occasional requirement to lift up to 15 pounds.

This is a Contract position based out of Birmingham, AL.

The pay range for this position is $50.00 - $55.00/hr.

Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
Medical, dental & vision Critical Illness, Accident, and Hospital 401(k) Retirement Plan Pre-tax and Roth post-tax contributions available Life Insurance (Voluntary Life & AD&D for the employee and dependents) Short and long-term disability Health Spending Account (HSA) Transportation benefits Employee Assistance Program Time Off/Leave (PTO, Vacation or Sick Leave)

This is a fully remote position.

This is a Contract position based out of Birmingham, AL.

The pay range for this position is $50.00 - $55.00/hr.

Individual compensation offered for this position within…