Prior Authorization Pharmacist

In this remote clinical role, you will evaluate prior authorization requests for formulary and non-formulary medications. You will leverage evidence-based guidelines and regulatory standards to render timely clinical determinations while serving as a trusted partner to healthcare providers, pharmacies, and health plan teams. Shift: Monday - Friday (8:00am - 5:00pm PST) Requirements: Licensure: Active, unrestricted Pharmacist (PharmD or RPh) license in your state of residence. Direct Experience: Must have hands‑on experience as a Licensed Pharmacist conducting clinical reviews and rendering decisions on prior authorizations (PAs) within a Pharmacy Benefit Manager (PBM), PBM‑adjacent platform, or health plan environment. Technical Proficiency: Demonstrated experience working within pharmacy benefit management (PBM) systems, prior authorization platforms, and electronic health/documentation software in a remote setup. Communication: Outstanding verbal and written communication skills for engaging with providers, health plan representatives, and clinical peers telephonically and digitally. Key Responsibilities Clinical Review & Determination: Evaluate prior authorization requests for formulary and non-formulary medications; render timely approval, denial, or modification decisions based on evidence‑based guidelines, clinical criteria, and regulatory standards. Documentation & Communication: Maintain precise records of clinical rationale and case details in internal systems while clearly communicating determinations, coverage policies, and alternative therapeutic options to prescribers and pharmacies. Operational & Team Support: Serve as a subject‑matter clinical resource for escalated inquiries, offering guidance on benefit interpretation, step‑therapy substitutions, formulary exceptions, and workflow troubleshooting. #J-18808-Ljbffr