Prior Authorization Pharmacist (PBM) - Remote

Prior Authorization Pharmacist (PBM) - Remote

Pay: $53.00 an hr
Duration: Contract to hire
Work Setup: Fully remote (continental U.S.) — cannot be in New Mexico or Colorado
Hours: 40 hrs/week

Schedule (CST hours required)

Candidates will work one weekend day each week on one of these schedules:

• Sun–Thu or Tue–Sat
• 10:30am–7:00pm CST
• 11:00am–7:30pm CST
• 11:30am–8:00pm CST

Training (Mandatory)

10/12/2026 – 11/25/2026 (first 7 weeks)
Mon–Fri, 8:00am–4:30pm CST

Position Summary

Seeking an experienced Pharmacist to complete criteria-based clinical reviews and render prior authorization coverage determinations based on plan design, clinical guidelines, and regulatory requirements. This role supports specialty and non-specialty pharmacy programs and includes high-volume provider interaction.

Key Responsibilities

• Review prior authorization requests for accuracy, appropriateness, and medical necessity
• Interpret clinical criteria and plan guidelines; gather/assess clinical documentation
• Communicate approvals/denials/incomplete requests to providers and patients
• Handle high-volume inbound/outbound calls (approx. 50 calls/day)
• Manage a daily workload (approx. 40 PA cases/day)
• Document determinations and communication thoroughly and accurately
• Support technicians and PA team to meet service level requirements

Required Qualifications

• Active Pharmacist license (required)
• 2+ years of prior authorization review experience (required)
• PBM / Managed Care / Health Plan experience (strongly preferred)
• Specialty pharmacy exposure (plus)
• Strong communication + documentation skills; comfortable in a high-production environment
• Able to work CST hours and one weekend day weekly
• High school diploma/GED (verifiable) required
• Bachelor’s in Pharmacy required (PharmD preferred)

Remote/Equipment Requirements (Must Meet)

• Provide your own high-speed internet: minimum 25 Mbps download / 3 Mbps upload
• Smartphone required (VPN token will be installed on phone)
• Private, secure workspace (conversations/screens/documents not accessible to others)
• Must be able to comply with teleworker privacy/security requirements
• Assignment may be changed to in-office in the future (must acknowledge)