Remote Prior Authorization Pharmacist {176011}

Job Description

Job Description

Remote Prior Authorization Pharmacist

Location: Fully Remote (work from home) — anywhere in the continental U.S. except New Mexico and Colorado

Pay rate: $53 an hr
Schedule: Full-time, 40 hrs/week
Shifts (CST): Sunday–Thursday or Tuesday–Saturday

• 10:30 AM – 7:00 PM CST
• 11:00 AM – 7:30 PM CST
• 11:30 AM – 8:00 PM CST

Start date: Nov 9th, 2026

Training (required): November 9, 2026 – December 4, 2026 , Monday–Friday 8:00 AM – 4:30 PM CST
Pay Rate: $53.00/hour (W2)
Position Type: Contract (class start)

Overview

We are seeking an experienced Pharmacist/Clinician to support a high-volume prior authorization (PA) / coverage determination team. This is an operations-based, fully remote role focused on applying clinical criteria and plan design to make timely coverage decisions and communicate determinations effectively.

Core Responsibilities

• Review prior authorization requests and render coverage determinations using clinical criteria and plan design
• Verify coverage/eligibility and interpret clinical guidelines
• Communicate determinations promptly and accurately to providers and other stakeholders
• Collaborate with PA team members/technicians to obtain needed clinical information and meet SLAs
• Handle inbound/outbound calls (providers/members/internal teams) and assist with escalations
• Maintain knowledge of drug and disease states for specialty and non-specialty programs
• Participate in training and other assigned projects (may include after-hours/on-call needs for urgent requests as required)

Requirements

• Active Pharmacist license (must be included at the top of the resume)
• 1–3+ years of prior authorization experience (3–5 preferred)
• Strong clinical review skills, attention to detail, and documentation
• Comfortable in a productivity-driven environment (high volume workflow; frequent provider interaction)
• Ability to work one weekend day weekly (based on assigned schedule)

Preferred / Strongly Desired

• PBM / Managed care / health plan experience
• Specialty pharmacy PA exposure (plus)

Remote Work / Technology Requirements (must meet)

• High-speed internet: minimum 25 Mbps download / 3 Mbps upload
• Provide internet speed test screenshot and internet provider + download/upload speeds (include at top of resume)
• Smartphone required (VPN token app will be installed)
• Private, secure, dedicated workspace (conversations cannot be overheard; screens/documents not viewable by others)
• Ability to comply with teleworker privacy and information security requirements

Resume Submission Must Include (Top of Resume)

• Active Pharmacist license info
• Internet speed test screenshot (or documented results)