Remote Pharmacist; Prior Authorization​/PBM

Remote Pharmacist (Work From Home) – Prior Authorization / Coverage Determination

We’re hiring experienced Remote Pharmacists to complete clinical prior authorization reviews and make coverage determinations using plan criteria.

Pay: $53/hr

Location:

100% Remote (continental U.S.; not available in NM or CO)

Schedule Options (CST):
Sun–Thurs OR Tues–Sat | 10:30a–7:00p, 11:00a–7:30p, or 11:30a–8:00p

Training:
Nov 9 – Dec 4 | Mon–Fri 8:00a–4:30p CST (mandatory)

• Review prior authorization requests and render coverage determinations using clinical criteria and plan design.
• Collaborate with technicians/prior auth team to gather clinical information and resolve escalations.
• Handle inbound/outbound calls with providers and teams; communicate approvals/denials clearly.
• Document determinations accurately and maintain strict PHI/privacy compliance.
• Manage daily case volume and follow established SLAs and workflows.

• Active Pharmacist license in the state of residence/practice (must be in good standing).
• Prior authorization experience strongly preferred (PBM/managed care a plus).
• MTM, DUR, or clinical review/documentation experience helpful.
• Strong provider communication and decision documentation skills.
• Stable work history and professionalism (clean, well-written resume matters).
• WFH requirements (must have)
• High-speed internet (min 25 Mbps down / 3 Mbps up) + speed test screenshot.
• Smartphone required (token/VPN access).
• Private, secure workspace (no interruptions).