Remote Licensed Prior Authorization Pharmacist

Job Summary

Seeking a Remote Licensed Prior Authorization Pharmacist to join a fully remote team, where the pharmacist will evaluate prior authorization requests, apply clinical criteria, and communicate coverage determinations while working part-time or full-time hours, including one weekend day each week.

Key Responsibilities

• Review and evaluate prior authorization requests, applying plan criteria and clinical guidelines
• Support technicians and prior authorization team members while handling inbound and outbound provider and member calls
• Maintain expertise in specialty and non-specialty pharmacy programs and stay current on disease states and drug therapies

Required Qualifications

• Active Pharmacist License in the state of residence
• BS in Pharmacy required; PharmD preferred
• 2+ years of prior authorization experience preferred
• Experience in PBM, Managed Care, or Health Plan strongly preferred
• Ability to manage approximately 50 provider calls daily and review approximately 40 prior authorization cases per day