Pharmacist

Job Title: Clinical Pharmacist
Job Description
The Clinical Pharmacist evaluates prior authorization and appeal requests by reviewing clinical documentation and making coverage determinations based on established criteria. This role focuses on clinical evaluation rather than dispensing, and involves close collaboration with prescribers, pharmacies, and internal teams to gather necessary information, document decisions, and communicate outcomes. The pharmacist ensures all reviews are accurate, timely, and compliant with applicable regulatory and client requirements, while actively contributing to process and workflow improvements within the prior authorization program and making a meaningful impact on patient care.
Responsibilities

• Review prior authorization and appeal requests by evaluating clinical documentation and applying established clinical and coverage criteria.
• Make clear, defensible coverage determinations and document medical necessity decisions in a thorough, accurate, and compliant manner.
• Collaborate with prescribers, pharmacies, and internal teams to obtain complete and accurate clinical information needed for coverage decisions.
• Communicate coverage decisions and clinical rationale to providers, pharmacies, or members in both written and verbal form.
• Differentiate between medical benefit and pharmacy benefit coverage and apply appropriate criteria and workflows for each.
• Evaluate and process cases involving specialty medications, including biologics, oncology therapies, immunology treatments, and rare disease therapies.
• Support appeals processing by preparing or reviewing first-level, second-level, or external review submissions as needed.
• Use pharmacy benefit management platforms, prior authorization systems, workflow tools, ticketing systems, or case management systems to manage clinical reviews and track case progress.
• Work efficiently in a production-driven, high-volume environment while maintaining strong attention to detail, accuracy, and quality standards.
• Ensure all prior authorization and appeal reviews comply with CMS, state-level, and payer regulatory requirements.
• Identify workflow or policy inefficiencies and contribute to process improvements within the prior authorization program.
• Participate in a culture of continuous improvement by providing and receiving constructive feedback to enhance quality and efficiency.
• Leverage technology and digital platforms, including Microsoft Office and shared documentation tools, to support daily clinical review activities.
• Maintain a positive, proactive, and solution-oriented mindset while managing multiple high-priority tasks and deadlines.

Essential Skills

• Active pharmacist license in the state of residence.
• Doctor of Pharmacy (PharmD) degree or equivalent pharmacy education.
• Prior experience with prior authorization review (strongly preferred).
• Experience working with multiple pharmacy benefit management (PBM) platforms and payer-specific prior authorization workflows.
• Familiarity with medical benefit versus pharmacy benefit coverage determinations.
• Exposure to appeals processing, including first-level, second-level, or external review submissions.
• Working knowledge of managed care, utilization management, or health plan operations.
• Experience communicating clinical rationale to providers, pharmacies, or members in written and verbal formats.
• Comfort reviewing specialty medications such as biologics, oncology agents, immunology therapies, and rare disease treatments.
• Understanding of CMS, state-level, and payer regulatory requirements related to prior authorization.
• Experience using workflow, ticketing, or case management systems for clinical reviews.
• Ability to work efficiently in a production-driven, high-volume environment while maintaining quality and accuracy.
• Strong attention to detail with a commitment to accuracy and quality in clinical decision-making and documentation.
• Excellent verbal, written, organizational, and interpersonal communication skills.
• Proficiency with technology and digital platforms, including Microsoft Office, shared documentation tools, PBM systems, and the ability to quickly learn new systems.
• Self-motivated with a positive, proactive, and solution-oriented mindset.

Additional Skills & Qualifications

• Pharmacy benefits management (PBM) experience.
• Experience in managed care or health plan settings.
• Experience in utilization management or similar review-based clinical roles.
• Experience supporting high-volume or metrics-driven environments while maintaining high quality standards.
• Ability to identify process inefficiencies and contribute to workflow or policy improvements.
• Openness to providing and receiving constructive feedback to support continuous improvement.
• Interest in practicing at the top of license with a focus on clinical evaluation and coverage decision-making rather than dispensing or retail metrics.
• Desire to make a meaningful clinical impact by supporting timely, patient-focused, and defensible medication decisions.

Work Environment
This role is a 100% work-from-home position, allowing the Clinical Pharmacist to perform all responsibilities remotely. The majority of the workday is spent seated at a desk using a computer for clinical review activities. The position requires regular use of a computer keyboard, mouse, and calculator, as well as frequent interaction with digital platforms such as PBM systems, workflow tools, and shared documentation applications. On occasion, the role may require lifting up to 15 pounds, such as moving equipment or materials in the home office environment. The work setting is production-driven and metrics-oriented, yet emphasizes quality, accuracy, and thoughtful clinical decision-making over volume alone, offering a professional, technology-enabled environment where pharmacists can focus on clinical evaluation and coverage decisions.
Job Type & Location
This is a Contract position based out of Birmingham, AL.
Pay and Benefits
The pay range for this position is $50.00 - $55.00/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a fully remote position.
Application Deadline
This position is anticipated to close on Jun 22, 2026.
About Actalent


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