Fully Remote Pharmacist

OptumRx is seeking licensed Pharmacists to support a high-volume, fully remote pharmacy operation. This position is responsible for reviewing medication prior authorization and appeal requests and determining coverage based on clinical guidelines, pharmacy policies, and health plan benefits.

Pharmacists will review patient clinical information, make coverage determinations, recommend formulary alternatives, and collaborate with providers, pharmacy technicians, and internal teams. This is a fast-paced, production-driven environment requiring strong clinical judgment, attention to detail, organization, and the ability to work independently.

Day-to-Day Responsibilities

• Review prior authorization requests
• Review medication appeal cases
• Analyze patient clinical information and documentation
• Make coverage determinations based on established guidelines
• Recommend appropriate formulary alternatives
• Communicate with physicians and healthcare providers
• Collaborate with pharmacy technicians and internal teams
• Accurately document case decisions
• Ensure compliance with Medicare Part D, Medicaid, commercial benefit, and regulatory requirements
• Manage a high daily case volume
• Meet established productivity and quality metrics
• Respond to provider and pharmacy inquiries
• Support quality assurance efforts

Participate in process improvement initiatives