Remote - Prior Authorization Pharmacist

Pay: From $53.00 per hour

Job description:

Remote Prior Authorization Pharmacist – (Fully Remote)

Pay Rate: $53.00/hr.
Location: Fully Remote – Candidates may work anywhere in the continental United States except New Mexico and Colorado.

Schedule: Sun–Thurs or Tues–Sat (Candidates must work CST hours and one weekend day each week)

Shift Options:

10:30 AM – 7:00 PM CST
11:00 AM – 7:30 PM CST
11:30 AM – 8:00 PM CST
Start Date: October 12, 2026

Required Documents – Must Be Included at the Top of the Resume

Candidates must include the following items at the top of their resume in order to be considered:

Active Pharmacist License (screenshot or copy)
Internet Speed Test Screenshot
Computer Proficiency Assessment (free online basic computer skills assessment)
Completed Candidate Questionnaire
Position Summary

Seeking Pharmacists to join a fully remote Prior Authorization team supporting Commercial Specialty and Non-Specialty Pharmacy programs. This operations-based clinical role is responsible for evaluating prior authorization requests, applying evidence-based clinical criteria, and communicating coverage determinations to providers, members, and healthcare stakeholders.

The Pharmacist will conduct clinical reviews, collaborate with technicians and prior authorization teams, answer provider questions, and support timely decision-making while meeting service level expectations.

This role requires strong clinical judgment, prior authorization experience, excellent communication skills, and the ability to thrive in a high-volume remote environment.

Key ResponsibilitiesPrior Authorization Reviews (60%)

Review and evaluate prior authorization requests
Apply plan criteria, clinical guidelines, and policy requirements
Verify insurance eligibility and coverage
Consult with physicians and healthcare providers as needed
Render approval and denial determinations
Communicate decisions accurately and within required timelines
Team Collaboration & Provider Support (25%)

Support technicians and prior authorization team members
Collect clinical information needed for review
Handle inbound and outbound provider and member calls
Resolve escalated prior authorization cases
Clinical Knowledge & Education (10%)

Maintain expertise in specialty and non-specialty pharmacy programs
Stay current on disease states and drug therapies
Additional Duties (5%)

Attend training and team meetings
Participate in after-hours or urgent PA support as needed
Complete special projects as assigned
Ideal Candidate Profile

Active Pharmacist License in state of residence/practice
BS Pharmacy required; PharmD preferred
2+ years of Prior Authorization experience preferred
PBM, Managed Care, or Health Plan experience strongly preferred
Specialty Pharmacy experience preferred
Comfortable reviewing approximately 40 PA cases per day
Comfortable managing approximately 50 provider calls daily
Strong documentation and communication skills
Proven success working remotely
Able to work one weekend day each week
Available for the full training period
Preferred Experience

Experience with systems such as:

PBM and Health Plan platforms
Therapeutic specialty pharmacy experience is a plus.

Training Requirements

Training Dates: October 12, 2026 – November 25, 2026

Training Schedule:
Monday–Friday
8:00 AM – 4:30 PM CST

Candidates must attend all training sessions.

Remote Work Requirements

Candidates are required to provide their own equipment and work environment:

Internet Requirements

High-speed broadband internet required
Minimum:
25 Mbps Download
3 Mbps Upload
Internet speeds must be verified via speed test screenshot
Smartphone required for VPN authentication
Workspace Requirements

Private workspace with a door
Secure work environment
No unauthorized access to confidential information
Conversations and screens must not be visible or audible to others
Workstation must be locked or shut down when unattended
Candidates should understand that remote assignments may convert to in-office work if business needs change.

Candidate Questionnaire (Required)

Please answer the following questions:

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, RxClaim, Facets, GuidingCare, 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 October 12, 2026 through November 25, 2026, Monday–Friday, 8:00 AM–4:30 PM CST, and work the assigned schedule following training? (Yes/No)
Important Dates

Last Offer Date: 09/14/2026
Last Acceptance Date: 09/17/2026
Last Day to Clear Compliance: 10/02/2026
Start Date: 10/12/2026
ESJJP2
Benefits:

Dental insurance
Health insurance
Vision insurance
 
Work Location: Remote