Rhode Island Licensed Pharmacist

Job Summary

To support a high-volume PBM environment, the remote Rhode Island Licensed Pharmacist will complete clinical prior authorization reviews and make coverage determinations while working from home on a full-time basis.

Key responsibilities

• Review prior authorization requests and render coverage determinations using clinical criteria
• Collaborate with technicians and the prior authorization team to gather clinical information and resolve escalations
• Document determinations accurately while maintaining strict PHI/privacy compliance

Required qualifications

• Active Pharmacist license in Rhode Island, in good standing
• Prior authorization experience strongly preferred, especially in PBM/managed care
• Experience in MTM, DUR, or clinical review/documentation is helpful
• Strong provider communication and decision documentation skills
• Stable work history demonstrating professionalism