Pharmacist

A broadband connection and a smartphone are required.
Include screenshot of speed test and license at the top of the resume.
Candidates can work from anywhere in the continental U.S. with the exclusion of  New Mexico and Colorado  candidates.
Safety Sensitive
Shifts available (Sun-Thurs or Tues-Sat):
10:30am-7pm CST
11am-7:30pm CST
11:30am-8pm CST

Training dates: November 9th December 4th; training time: 8am to 4:30pm CST
Please do not submit candidates that were previously rejected on they will be rejected again.
They are required to provide their own high-speed internet.
Minimal home broadband connectivity speed of 25 Mb download and 3 MB upload speed. Speed for home internet can be confirmed by going to www.speedtest.net. Please provide Internet provider and download and upload speeds.
Smartphones are required. The VPN token will need to be downloaded to the users smartphone.
They must have a sufficient/private work area that is used for business during their work hours.
Their current living accommodations are in a stable situation.
That the assignment could be changed to an in-office assignment.
Ensure the employee is aware of the Teleworker Privacy Practices they need to abide by.
Must take steps to ensure that the work area is secure and protects  Health property and confidential information from inadvertent or unauthorized access or theft including:
Equipment and information are secure from inadvertent and/or unauthorized access or theft at all times.
Workspace is dedicated to  Health business during working hours and is not accessible by others who may be present in the household; telephone conversations cannot be overheard, and documents/computer screens cannot be viewed by others.
When not working, the computer is shut off. For short departures from the work area, the workstation must be locked, or the computer shut down.

Last Offer10/12/2026
Last Acceptance10/15/2026
MUST clear prior to10/30/2026

MUST be included at top of resume:
Active Pharmacist License
Internet Speed Test Screenshot
Candidate questionnaire must be completed

Candidate Questionnaire
What state(s) do you currently hold an active Pharmacist license in
How many years of Pharmacist experience do you have
How many years of Prior Authorization experience do you have
Describe your PBM, Managed Care, or Health Plan experience.
Have you reviewed Specialty Pharmacy prior authorizations If yes, please specify therapeutic areas.
What pharmacy systems and platforms have you used (Caremark, Rx Claim, Facets, Guiding Care, etc.)
What volume of prior authorization reviews did you complete daily in your most recent role
Have you communicated PA determinations directly with physicians, providers, or members Please explain.
Do you have a private workspace in your home with a door
Can you attend training from November 9th December 4th; training time: 8am to 4:30pm CST , and work the assigned schedule following training (Yes/No)
Ideal Candidate Profile
Active Pharmacist License
2%2B years of Prior Authorization review experience
PBM, Managed Care, or Health Plan experience strongly preferred
Specialty Pharmacy experience is a plus
Comfortable with high-volume inbound and outbound provider interaction
Approximately 50 calls per day
Able to manage approximately 40 prior authorization cases per day
Proven remote work experience
Strong communication and documentation skills
Available for the full training period
Comfortable working one weekend day each week

Enable Skills-Based Hiring No
Qualification Assessment
Must Have

Duties
Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design. Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols. One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval & denial management processes. (60%)
Collaborates with the technicians and prior authorization team members to process referrals, including answering clinical questions and collecting appropriate clinical/medical data needed to perform clinical assessments and reviews as per the health plan/employer-agreed criteria within the designated service level agreements. Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations. (25%)
Maintains professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered within the Commercial Specialty line of business.(10%)
Performs other related projects and duties as assigned, including attending training sessions and development meetings, and providing on-call and after-hours pharmacist availability as needed.(5%)

Experience
Previous pharmacy experience in PBM preferred. Appropriate state license required. Basic computer skills required. Strong organizational skill, interpersonal skills and detail orientation important for this position.

Prior Work Experience:
Required: 1 to 3 years
Preferred: 3 to 5 years

Position Summary
The Pharmacist/Clinician is an operation-based role that conducts criteria based & clinical review of medical data collected to perform prior authorization as per policy and procedure. The Pharmacist/Clinician will apply clinical knowledge to plan approved criteria for reviews of cases. This role will work from  Caremark supported systems and take inbound calls from physicians or members regarding their pending, approved, or denied prior authorizations, internally support the Prior Auth team and member services department, as well as provide on-call after hours availability for urgent PA request as needed.

Education
Required: Bachelor's Degree BS Pharmacy and an active pharmacist license in the state of practice/residence.
Preferred: Doctorate Pharm D
What days & hours will the person work in this position List training hours, if different.
Sun-Thurs or Tues-Sat, 10:30-19:00, 11:00-19:30, or 11:30-20:00; Training Mon-Fri 8:00-16:30