Remote Clinical Pharmacy Reviewer: Prior Authorization & DUR
Dane Street
- Remote job
Dane Street is seeking a Clinical Pharmacy Reviewer (Pharmacist) to evaluate complex prior authorization requests, appeals, and medication coverage determinations in a remote setting. The role applies evidence-based guidelines, formulary management, and Drug Utilization Review (DUR) to ensure medical necessity and regulatory compliance, impacting healthcare delivery. Active pharmacist license in the U.S. and a PharmD are required, with at least three years in PBM prior authorization work, #J-18808-Ljbffr Dane Street
- The Clinical Pharmacy Reviewer (Pharmacist) evaluates complex prior authorization requests, appeals, and medication coverage determinations... ...Drug Utilization Review (DUR) and objective decision-making... ...Join Dane Street? Collaborative remote culture Professional growth opportunities...Remote jobLocal areaWork from home
$57 per hour
...ProPivotal Staffing is seeking a Clinical Pharmacist Reviewer to work from home in Massachusetts. This role supports clinical pharmacy services and involves optimizing treatments with healthcare teams. Candidates should have 1-2 years of experience and an active Massachusetts...Remote workHourly payWork from homeFlexible hours$22 - $23 per hour
...Remote Clinical Pharmacy Clerk Atlanta, Georgia, United States $ 22.00 - 23.00 (US Dollar) About the Job Remote Clinical Pharmacy... ...and/or members/members representatives for pharmacy prior authorizations, exceptions, and appeals Enter authorizations and test...Remote jobWork at office$53 per hour
...Remote Pharmacist (Work From Home) – Prior Authorization / Coverage Determination We’re hiring experienced Remote... ...Pharmacists to complete clinical prior authorization reviews and make coverage determinations... ...care a plus). MTM, DUR, or clinical review/documentation...Remote workWork from home$50 - $52 per hour
...Claims Clinical Documentation Reviewer Schedule: 5-10 hours per week. Resource can... ...weekends if they prefer. Remote position. Equipment is provided... .... Knowledge Service Authorization concepts, principles, and... ...and implementation, prior authorization functions and...Remote workPart timeWork at officeLong distance10 hours per week- ...CorroHealth Inc. seeks a remote Clinical Reviewer to support the WISeR Prior Authorization Program across the US. You will perform clinical reviews, validate documentation, and support physician determinations in CMS-aligned workflows. The role emphasizes accuracy,...Remote work
- ...Remote Drug Utilization Review Pharmacist Safe & Cost-Effective Medication Use Work... ...use patterns, apply clinical guidelines, and collaborate... ...improvement initiatives and pharmacy program development. What... ...population-health pharmacy, many DUR roles offer hybrid or fully...Remote jobWork from home
- ...Actalent is seeking a Clinical Prior Authorization Reviewer to join our remote team supporting Dallas, TX operations. This contract role focuses on evaluating prior authorization requests for medical necessity and appropriate level of care using InterQual and Milliman...Remote workContract work
- A healthcare solutions provider is seeking a Remote Pharmacist to conduct VA quality reviews, focusing on clinical assessments without direct patient interaction. Candidates must have a Doctor of Pharmacy (PharmD) and an active pharmacist license in the U.S. Responsibilities...Remote workFlexible hours
$28.37 - $39.19 per hour
...through technology, services, and clinical expertise. Our mission is to... ...Health is looking for a Clinical Reviewer - Arkansas Behavioral Health License (Remote within Arkansas) to join our... ...contract requirements. Completes prior authorization, continued stay, and...Remote workContract workWork at officeLocal areaMonday to FridayFlexible hours$57 per hour
...Clinical Pharmacist Reviewer – Work From Home (MA) – Earn Up To $57/hr Remote position supporting clinical pharmacy services Competitive pay with room for career growth Help improve prior authorization & medication approval processes Work with top healthcare...Remote workWork from homeFlexible hours- ...Work Mode: 100% Remote - Open to any time zone EXCEPT... ...: Develop clinical criteria for medications... ...Monitor prior authorization requests Provide... ...performance improvement in pharmacy/practice Develop... ...programs designed to impact DUR for both Medicaid and...Remote workLocal areaShift work
- ...Position Title: Clinical Pharmacist Work Location: Remote - any time zone except... ...medication reviews for members that have... ...qualified for one of our pharmacy clinical programs.... ...Monitor prior authorization requests Provide... ...designed to impact DUR for both Medicaid...Remote workLocal area
$110k - $140k
...Clinical Quality Reviewer - BCBA About Onos Health Onos Health's mission is simple but ambitious... ...management, care review, or prior authorization review for a payer or managed care organization... ...office (Financial District), remote-first culture ~ Unlimited vacation...Remote workWork at officeHome officeFlexible hours2 days per week3 days per week$20 per hour
...Job Description Job Description Remote Prior Authorization Pharmacy Technician Location: Remote (U.S.) Schedule... ...requests Accurately document reviews and maintain timely, complete records Escalate clinical questions and judgment calls to the pharmacist...Remote jobFull timeContract workWork at officeWork from homeMonday to Friday- ...Elite Job is seeking a Part-Time Remote Patient Access Representative (Pharmacy) to join our growing healthcare support... ...coverage, processing medication authorizations, handling inquiries, and... ...details, prescription eligibility, and prior authorization requirements....Remote jobHourly payPart timeWork at officeWork from homeFlexible hoursShift work
- ...outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel... ...determine the viability of the claim for further review in a production environment. Primary Responsibilities: Clinical Case Reviews - 75% Perform clinical review...Remote jobContract workWork at officeLocal areaMonday to Friday
- ...reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs... ...Team Member.This position is REMOTE within US Only - Equipment providedThe Clinical Reviewer supports the WISeR Prior Authorization Program by performing comprehensive clinical...Remote workWork at officeImmediate startFlexible hoursAfternoon shift
$17 - $34.15 per hour
...CVS Health is seeking a Pharmacy Technician for Prior Authorization to work from home in Hawaii. This role involves processing and communicating prior authorization referrals for specialty medications while collaborating with customer service and pharmacy operations. Candidates...Remote workHourly payFull timeWork from home- ...is actively hiring licensed Pharmacists for remote Prior Authorization roles with multiple start dates and scheduling... ...time hours in a safety-sensitive, dedicated clinical support capacity. Responsibilities include reviewing and processing prior authorization requests,...Remote workFull timeWork from homeFlexible hours
- ...Line Staffing Solutions is seeking licensed Pharmacists for Remote Prior Authorization roles. These full-time, remote positions offer the... ...several start dates in October and November. Roles emphasize clinical decision-making, regulatory compliance, and collaboration...Remote workFull timeWork from homeFlexible hours
- ...A-Line Staffing Solutions is hiring Remote Prior Authorization Pharmacists to handle denials and authorizations from home across multiple shifts. You will review requests, apply clinical judgment, and communicate with providers while maintaining compliant, well-documented...Remote workFull timeWork from homeShift work
$53 per hour
...A-Line Staffing Solutions is seeking licensed Pharmacists for remote Prior Authorization roles in the United States. These full-time, home-based positions offer multiple start dates and flexible scheduling options with a pay rate of $53 per hour. Ideal candidates will...Remote workHourly payFull timeWork from homeFlexible hours$18 - $20 per hour
...Contact Center Representative (Remote) Fully Remote • US Remote... ...provider of value-based pharmacy care management solutions for... ...pharmacy team members based on clinical or urgent needs. Assist... ...patients with insurance, co-pays, prior authorizations, and general pharmacy...Remote workHourly payTemporary workWork at officeLocal areaHome officeVisa sponsorshipMonday to FridayShift work$53 per hour
...Remote Prior Authorization Pharmacist (Pharmacist – Prior Auth) Location: Remote... ...based prior authorization (PA) reviews and issue coverage... ...specialty and non-specialty pharmacy programs. This is a great fit... ...coverage determinations using clinical criteria and plan design Verify...Remote workFull timeWork from homeHome officeShift work$50 - $55 per hour
...client is a major PBM (Pharmacy Benefit Services)... ...Work from home (100% remote) - refer list of states... ...retrospective drug utilization review and appeals per State... ...the distribution of clinical drug information and... ...Provides prior authorization services for formulary...Remote workContract workWork from home- ...A-Line Staffing Solutions is hiring a Remote Pharmacist to perform criteria-based prior authorization reviews and issue coverage determinations for specialty and non-specialty programs. The role suits pharmacists with PBM/managed care experience who can handle high volumes...Remote workFull timeWork from homeHome officeShift work
- ...Central Prior Authorization Pharmacy TechnicianThe Central Prior Authorization Pharmacy Technician will... ...insurance workflows.This position can be remote, home-based position requiring... ...payers and specialty pharmacies to obtain clinical documentation and authorization...Remote workWork from home
- ...Remote USA, TN, Chattanooga, Remote Full time R-51534 We are hiring a Clinical Assistant at BCBST! In this role, you will support... ...goals. Perform projects, review and handle reports as... ...part of the notification /prior authorization process. This job requires...Remote workFull timeWork at officeWork from homeRelocation packageRotating shiftAfternoon shiftEarly shift
- ...extend *Must be Doctor of Pharmacy *Must have PBM/Prior Authorization experience *Must be... ...and Responsibilities • Review and render decisions on authorizations... ...to discuss the clinical rationale of adverse... ...during group training Remote working/work at home options...Remote workHourly payContract workImmediate startWork from homeShift workWeekend work
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