*Pharmacist
Posted 09/03/2026
Job ID:
175162
Job Description
Remote Prior Authorization Pharmacist
Pay: $53.00/hour
Work Arrangement: Remote
Schedule: Sunday–Thursday or Tuesday–Saturday
Time Zone: CST
Position Summary
We are seeking an experienced Pharmacist to review and process prior authorization requests while ensuring accuracy, medical necessity, regulatory compliance, and timely coverage determinations.
Key Responsibilities
Pay: $53.00/hour
Work Arrangement: Remote
Schedule: Sunday–Thursday or Tuesday–Saturday
Time Zone: CST
Position Summary
We are seeking an experienced Pharmacist to review and process prior authorization requests while ensuring accuracy, medical necessity, regulatory compliance, and timely coverage determinations.
Key Responsibilities
- Review prior authorization requests for accuracy, appropriateness, and medical necessity.
- Gather and evaluate clinical information, coverage policies, and authorization criteria.
- Make coverage determinations in accordance with regulatory and plan guidelines.
- Process Medicare Part D approvals and denials.
- Clearly communicate approval, denial, and incomplete-request decisions to providers and patients.
- Consult with physicians and healthcare providers regarding complex cases.
- Manage approximately 40 prior authorization cases per day.
- Handle approximately 50 inbound and outbound provider calls daily.
- Document clinical reviews, decisions, and communications accurately.
- Support process improvements designed to increase accuracy, streamline workflow, and reduce turnaround times.
- Active Pharmacist license required.
- 2+ years of prior authorization review experience required.
- PBM, managed care, or health plan experience strongly preferred.
- Specialty pharmacy experience is a plus.
- Strong clinical judgment, communication, and documentation skills.
- Experience working remotely preferred.
- Ability to work high-volume cases and provider interactions.
- Must be available for the entire training period.
- Candidates must work one weekend day each week.
- Candidates must be located in the continental U.S.; New Mexico and Colorado are excluded.
Meet Your Recruiter
Seth Klein
Account Manager
About Woonsocket, RI
Explore exciting job opportunities near Woonsocket, Rhode Island! Nestled in the picturesque New England region, Woonsocket offers a charming blend of historic charm and modern opportunities. With landmarks like the stunning Museum of Work & Culture, vibrant arts scene at the Stadium Theatre Performing Arts Centre, and delectable cuisine options ranging from classic clam bakes to trendy food trucks, this area promises a fulfilling career and a quality lifestyle. Join the proud community supporting local teams like the Pawtucket Red Sox at McCoy Stadium and savor outdoor adventures at the scenic World War II Veterans Memorial Park. Start your professional journey in Woonsocket, where every day offers a new chapter of growth and success.