Clinical Pharmacist – Prior Authorization (Remote)
Location: Fully Remote (Must reside in licensed state)
Pay: 53-55 per hour
Start Date: 6/8 or 6/15
Schedule
• 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