Rhode Island Licensed Pharmacist

Job Summary

To support a growing team, the full-time Remote Prior Authorization Pharmacist will conduct criteria-based prior authorization reviews and issue coverage determinations for specialty and non-specialty pharmacy programs while working from home.

Key responsibilities

• Review prior authorization requests and render coverage determinations based on clinical criteria and plan design
• Verify insurance eligibility and interpret clinical guideline criteria while consulting with providers as needed
• Document all activities clearly and accurately, maintaining current knowledge of drug and disease states

Required qualifications

• Active Rhode Island Licensed Pharmacist license (unrestricted; in good standing)
• Prior authorization review experience, preferably in PBM, managed care, or health plan settings
• Professional phone presence and comfort with provider outreach and high-volume workflows
• Able to work in a secure home office while maintaining HIPAA and privacy standards
• Reliable high-speed internet and a dedicated private workspace for training and scheduled shifts