Job Description
Clinical Pharmacist – Prior Authorization (Remote)
Location: Fully Remote (Must reside in licensed state)
Pay: 53-55 per hour
- Start Date: 6/8 or 6/15Schedule
- Must be available to work within:
- Monday–Friday: 7:00 AM – 8:00 PM CST
- Rotating weekends and holidays as needed
- Training schedule (if applicable):
- Monday–Friday, standard business hours
- Attendance required with no time off
- We are seeking a licensed Clinical Pharmacist (PharmD) to support prior authorization and coverage determination processes in a high-volume, call center environment. This role is responsible for reviewing clinical information, ensuring compliance with Medicare and payer guidelines, and collaborating with providers to support appropriate medication use.Key Responsibilities
- Review and evaluate prior authorization requests for medical necessity
- Apply Medicare Part D, CMS, and plan-specific clinical criteria
- Interpret clinical documentation, drug therapies, and treatment plans
- Communicate with providers to obtain additional clinical information
- Perform coverage determinations and support appeals processes
- Document all case activity accurately in multiple systems
- Ensure compliance with HIPAA and regulatory requirements
- Meet productivity, quality, and turnaround time expectations
- Escalate complex cases as needed Required Qualifications
- Doctor of Pharmacy (PharmD) required
- Active, unrestricted Pharmacist license in state of residence (must be listed on resume with expiration date)
- Experience with prior authorization, PBM, or managed care pharmacy
- Knowledge of Medicare Part D, drug benefits, and appeals processes
- Strong clinical judgment and attention to detail
- Excellent written and verbal communication skills Preferred Qualifications
- Previous call center or high-volume review experience
- Experience with coverage determinations and appeals
- Familiarity with multiple insurance types (Commercial, Medicare, Medicaid) Work Environment
- Remote, call center-based role
- Must be comfortable working in a fast-paced, metrics-driven environment
- Ability to sit for extended periods and manage a high volume of cases Work-From-Home Requirements
- Private, HIPAA-compliant workspace
- Wired internet connection required
- Minimum internet speed: 25 Mbps download / 5 Mbps upload Key Skills for Success
- Strong clinical evaluation and decision-making skills
- Ability to work independently and manage multiple cases
- High attention to detail and documentation accuracy
- Strong problem-solving and critical thinking abilities
- Effective communication with providers and internal teams
Please Contact: Katherine Skelton
586-710-0022
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