Job Title: Remote PBM Prior Authorization Pharmacist

Pay: $53 an hr | Bi-weekly

Job Type: Remote (Must be licensed in North Carolina but can live in any state)

Start date: 06/12/25

Shift Options:

• Shift 11am to 730pm EST

• Schedule Training: Mon - Fri 8am - 430 PM EST Starting 06/2/2025. Training will be 4 weeks

Remote PBM Prior Authorization Pharmacist Overview:

• This position is for a Clinical Pharmacist working in the Prior Authorization team. This Pharmacist will:
  Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design.
• Includes verifying insurance coverage and eligibil­ity, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols.
• One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval & denial management processes.
• Collaborate with the technicians and prior authorization team members to process refer­rals, including answering clinical questions and collecting appropriate clinical/medical data needed to perform clinical assessments and reviews as per the health plan/employer- agreed criteria within the designated service level agreements.
• Performs and handles in­ bound and outbound phone calls with technicians, prior authorization team members, physi­cians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations.
• Maintain professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered within the Commercial Prior Authorization and Case Review Unit (CRU) line of business.
• Perform other related projects and duties as assigned, including attending training ses­sions and development meetings, and providing on-call and after-hours pharmacist avail­ ability as needed.

Remote PBM Prior Authorization Pharmacist Qualifications:

• Hold and maintain an active, unencumbered Pharmacist license in North Carolina.
• Position requires proficiency with computer skills which include multitasking, navigating multiple systems, and keyboarding.
• Experience using MS Office, other Windows­ based computer applications, web based processing and telephony programs.
• Minimum 2 years’ recent experience reviewing and processing prior authorizations against health plan criteria for a determination in a specialty/skilled clinical setting i.e., specialty medical office or Pharmacy Benefits Manager (PBM)

Remote PBM Prior Authorization Pharmacist Benefits:

• Benefits are available to full-time employees after 90 days of employment and include health, optical, dental, life, and short-term disability insurance.
• A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates.

How to Apply:

If you are interested in this position, please apply OR submit your resume to:

Saw Hlaing | shlaing@alinestaffing.com | 412-790-5425