Prior Authorization Pharmacist

Review and make determinations on prior authorization requests for medications under the pharmacy benefit Conduct peer-to-peer calls with prescribers regarding adverse determinations Participate in clinical quality audits and inter-rater reliability testing Support internal teams with pharmacy escalations and clinical questions Apply clinical expertise to ensure appropriate and safe medication use Maintain compliance with all applicable laws and regulations Required Qualifications Doctor of Pharmacy (PharmD) 3+ years of experience working as a licensed pharmacist Willingness to obtain additional state licenses and/or training as needed Preferred Background 1+ year of managed care clinical review experience and/or experience writing clinical criteria Prior authorization, utilization management, PBM, or clinical review experience Strong experience applying clinical criteria Board certification such as BCPS or BCOP Residency training Pay $60/hour Start Date 10/26/2026 Contract Duration Through April 2026 Limited PTO is requested from January through March due to busy season Any planned PTO during the contract must be provided with the candidate’s resume Schedule Candidates will eventually need to work at least one weekend shift per week, either Saturday or Sunday Potential schedules include four 10-hour shifts or five 8-hour shifts Training will be M-F, 8:30 AM–5:00 PM CST Weekend shifts are expected to begin approximately two months after the start date Training 3–4 weeks of group training Combination of self-study and instructor-led training No PTO requested during the training period Candidate completes a case study within 48 business hours of receiving it Candidates who pass the case study move into interviews 30 minutes with a Senior Clinical Pharmacist 30 minutes with a Pharmacist Supervisor Location / Remote Requirements This appears to be a fully remote position, but candidates must reside and perform their work in one of the approved states unless otherwise approved by the Insurance Group. Approved locations include: AL, AZ, AR, CO, CT, DC, FL, GA, ID, IL, IN, IA, KS, KY, ME, MD, MA, MI, MN, MS, MO, NE, NV, NH, NJ, NM, NY, NC, OH, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA and WI. #J-18808-Ljbffr MedOp Solutions