Prior Authorization Pharmacist

Job Title: Prior Authorization Pharmacist (Pennsylvania Pharmacist License Required) Client: East Coast Healthcare Provider Length: 6-month Contract with high probability of FTE conversion Location: 100% Remote (EST Hours) Start Date: Mid-October 2026 Openings: 5 total openings Job Description: The Prior Authorization Pharmacist supports health plan clinical operations by performing comprehensive clinical reviews of coverage requests, prior authorizations, appeals, and coverage determinations across a broad range of medical and pharmacy services. This role is responsible for applying clinical expertise, evidence-based guidelines, health plan policies, benefit requirements, and regulatory standards to complex member cases. The pharmacist will evaluate requests across multiple service lines and collaborate with physicians, nurses, case managers, medical directors, providers, and other clinical stakeholders to ensure appropriate, safe, and cost-effective utilization of healthcare services. In addition to traditional pharmacy prior authorization responsibilities, this position has a strong focus on appeals and reconsiderations, complex care coverage, utilization management, and cross-service-line clinical review. The ideal candidate will have health plan or payer experience, strong utilization management knowledge, and the ability to independently evaluate complex clinical cases involving multiple diagnoses, therapies, services, and levels of care. Responsibilities: Perform the clinical review of Prior Authorization, Step Therapy, Quantity Limit, and all other pharmacy utilization management requests in accordance with quality, timeliness, and efficiency standards. Critically review pharmacy utilization management requests for approval/denial against standard clinical criteria and regulatory approved policies. Participate in a clinical call queue to receive inquiries from internal and external stakeholders pertaining to the exception process while answering in a timely, accurate and professional manner. Participate in the pharmacy appeals process through the review of denied cases as well as serving as committee representation at fair hearings. Participate in and contribute to other operational initiatives on an as needed basis. Skill Set Requirements: Bachelor of Science Degree in Pharmacy or Doctor of Pharmacy Degree (Pharm.D.) from an accredited U.S. School of Pharmacy. Minimally, 1-3 years practicing as a licensed pharmacist. Managed care residency or 1-3 years managed care experience, preferably in the development and execution of multiple utilization management techniques such as prior authorization, step therapy, quantity level limits, and other dose optimization techniques. Effective communication skills, both written and oral. Proficient drug information and literature evaluation skills. Demonstrate proficient analytical ability and organizational skills. Must possess strong drug information and literature evaluation skills. Strong technology proficiency, including word processing, use of email/Outlook, and the ability to quickly learn and navigate various software applications, platforms, and digital tools used in daily operations, such as Microsoft Teams. Assessment of job-related skills and competencies will be reviewed annually via daily functioning, job-related documentation, department-based competency programs, and continuing education activities. Education/Certification(s)/License(s): Registration as a registered pharmacist (RPh), in the Commonwealth of Pennsylvania or eligibility for licensure by examination or reciprocity. Continuing Education requirements met each bi-annual cycle for re-licensure, as evident by obtaining a minimum of 30 hours of continuing education every 2 years in structured pharmaceutical education as necessary by the state board. EEO Statement: Medasource is an equal opportunity employer that does not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, lactation and related medical conditions), gender identity or gender expression, sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and Ordinances. Benefits & Perks: Medasource offers competitive medical, dental, vision, Health Savings Account, Dependent Care FSA, and supplemental coverage with plans that can fit each employee’s needs. We offer a 401k plan that includes a company match and is fully vested after you become eligible, paid time off, sick time, and paid company holidays. Pay Disclaimer: The pay range for this job level is a general guideline only and not a guarantee of compensation or salary. Additional factors considered in extending an offer include (but are not limited to) responsibilities of the job, education, experience, knowledge, skills, and abilities, as well as internal equity, alignment with market data, applicable bargaining agreement (if any), or other law.