Prior Authorization Pharmacist (PBM) - Remote
Job Description
Prior Authorization Pharmacist (PBM) - Remote
Pay: $53.00 an hr
Duration: Contract to hire
Start date: 10/12/26
Work Setup: Fully remote (continental U.S.) — cannot be in New Mexico or Colorado
Hours: 40 hrs/week
Schedule (CST hours required)
Candidates will work one weekend day each week on one of these schedules:
- Sun–Thu or Tue–Sat
- 10:30am–7:00pm CST
- 11:00am–7:30pm CST
- 11:30am–8:00pm CST
Training (Mandatory)
10/12/2026 – 11/25/2026 (first 7 weeks)
Mon–Fri, 8:00am–4:30pm CST
Position Summary
Seeking an experienced Pharmacist to complete criteria-based clinical reviews and render prior authorization coverage determinations based on plan design, clinical guidelines, and regulatory requirements. This role supports specialty and non-specialty pharmacy programs and includes high-volume provider interaction.
Key Responsibilities
- Review prior authorization requests for accuracy, appropriateness, and medical necessity
- Interpret clinical criteria and plan guidelines; gather/assess clinical documentation
- Communicate approvals/denials/incomplete requests to providers and patients
- Handle high-volume inbound/outbound calls (approx. 50 calls/day)
- Manage a daily workload (approx. 40 PA cases/day)
- Document determinations and communication thoroughly and accurately
- Support technicians and PA team to meet service level requirements
Required Qualifications
- Active Pharmacist license (required)
- 2+ years of prior authorization review experience (required)
- PBM / Managed Care / Health Plan experience (strongly preferred)
- Specialty pharmacy exposure (plus)
- Strong communication + documentation skills; comfortable in a high-production environment
- Able to work CST hours and one weekend day weekly
- High school diploma/GED (verifiable) required
- Bachelor’s in Pharmacy required (PharmD preferred)
Remote/Equipment Requirements (Must Meet)
- Provide your own high-speed internet: minimum 25 Mbps download / 3 Mbps upload
- Smartphone required (VPN token will be installed on phone)
- Private, secure workspace (conversations/screens/documents not accessible to others)
- Must be able to comply with teleworker privacy/security requirements
- Assignment may be changed to in-office in the future (must acknowledge)