Clinical Pharmacist

Pharmacist – Prior Authorization | Fully Remote
Job Title: Pharmacist – Prior Authorization
Location: Fully Remote
Job Type: 12-Month Contract with Strong Extension Possibilities
Schedule: Sun–Thurs OR Tues–Sat
Work Hours: CST Hours
Training: Monday–Friday, 8:00 AM–4:30 PM CST for the first 7 weeks

Key Responsibilities
Evaluate and review prior authorization requests and make coverage determinations based on clinical criteria, plan design, and established policies.
Verify insurance coverage and member eligibility.
Interpret and apply clinical guidelines and criteria to individual cases.
Utilize clinical knowledge, drug information, disease-state resources, and other appropriate references when conducting reviews.
Consult with physicians and other healthcare providers when additional clinical information is required.
Communicate approval and denial decisions accurately and within established service-level requirements.
Ensure all case documentation is complete, accurate, timely, and compliant with department protocols.

Required Qualifications
Active Pharmacist License in the state of practice/residence.
2+ years of Prior Authorization review experience.
Bachelor's Degree in Pharmacy (BS Pharmacy) required.
Strong understanding of clinical criteria and medication management.
Strong computer skills and ability to learn and navigate multiple systems.
Excellent written and verbal communication skills.
Strong organizational skills and attention to detail.
Ability to manage approximately 40 prior authorization cases per day.
Comfortable handling approximately 50 calls per day.
Proven experience working successfully in a remote environment.
Strong documentation and clinical decision-making skills.
Ability to work one weekend day every week.
Must be available for the full 7-week training period.