Pharmacist - Prior Authorization

About the Role

We are seeking an experienced Pharmacist with a strong background in Pharmacy Benefit Management (PBM) to join our growing team. This role focuses on prior authorization adjudication and appeals, ensuring clinically sound and compliant decisions that support optimal patient outcomes.

This is a fully remote position open to candidates residing anywhere in the United States.

Key Responsibilities

• Review and adjudicate prior authorization requests in accordance with clinical guidelines and plan criteria
• Evaluate and process appeals, including complex and escalated cases
• Apply evidence-based clinical knowledge to ensure appropriate medication use
• Collaborate with healthcare providers, internal teams, and stakeholders to resolve authorization and appeal inquiries
• Maintain compliance with regulatory requirements, client policies, and internal procedures
• Document decisions clearly and accurately within systems
• Stay current with formulary changes, clinical guidelines, and industry trends

Please email your resume to Michael Nichols at

• Review and adjudicate prior authorization requests in accordance with clinical guidelines and plan criteria
• Evaluate and process appeals, including complex and escalated cases
• Apply evidence-based clinical knowledge to ensure appropriate medication use
• Collaborate with healthcare providers, internal teams, and stakeholders to resolve authorization and appeal inquiries
• Maintain compliance with regulatory requirements, client policies, and internal procedures
• Document decisions clearly and accurately within systems
• Stay current with formulary changes, clinical guidelines, and industry trends

Please email your resume to Michael Nichols at