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Remote Pharmacist – Prior Authorization

Fully Remote

A-Line Staffing is hiring Registered Pharmacists for a fully remote Prior Authorization opportunity supporting Commercial Specialty and Non-Specialty Pharmacy programs.

This position is ideal for an experienced pharmacist with Prior Authorization, PBM, Managed Care, Health Plan, Specialty Pharmacy, or clinical review experience who is comfortable performing high-volume clinical reviews and communicating with providers, physicians, members, and internal pharmacy teams.

Opportunity for full-time employment contingent on performance.

Position Details

• Position: Pharmacist/Clinician – Prior Authorization
• Job Type: Full-Time
• Work Arrangement: Fully Remote – Never Onsite
• Excluded States: New Mexico and Colorado
• Start Date: November 9, 2026
• Schedule: Sun–Thurs OR Tues–Sat
• Available Shifts:
• 10:30 AM–7:00 PM CST
• 11:00 AM–7:30 PM CST
• 11:30 AM–8:00 PM CST
• Training: November 9–December 4, 2026
• Training Schedule: Monday–Friday, 8:00 AM–4:30 PM CST

Position Summary

The Pharmacist/Clinician is responsible for conducting criteria-based and clinical review of prior authorization requests in accordance with established policies and procedures.

The pharmacist will evaluate clinical information, verify coverage and eligibility, interpret clinical criteria and plan requirements, and render appropriate coverage determinations.

The position also involves working closely with prior authorization technicians and other team members, answering clinical questions, collecting additional clinical information, and conducting inbound and outbound calls with physicians, healthcare providers, patients, and internal teams.

Key Responsibilities

Prior Authorization & Clinical Review

• Evaluate and review prior authorization requests.
• Render coverage determinations based on clinical criteria and plan design.
• Verify insurance coverage and eligibility.
• Interpret applicable clinical guidelines and criteria.
• Apply clinical knowledge and appropriate pharmacy resources when reviewing cases.
• Consult with physicians and other healthcare providers as needed.
• Ensure decisions are processed and communicated promptly according to established approval and denial procedures.
• Review both Specialty and Non-Specialty Pharmacy prior authorization requests.

Provider & Member Communication

• Conduct inbound and outbound calls with:
• Physicians
• Healthcare providers
• Patients/members
• Prior authorization team members
• Pharmacy technicians
• Answer clinical questions related to prior authorization requests.
• Obtain additional clinical or medical information needed to complete reviews.
• Resolve escalations appropriately.
• Communicate approval and denial determinations according to established procedures.

Team Collaboration

• Collaborate with technicians and prior authorization team members to process referrals.
• Provide clinical support to the Prior Authorization team.
• Support Member Services with clinical questions when appropriate.
• Participate in training sessions, development meetings, and other assigned projects.
• Provide on-call or after-hours pharmacist availability for urgent PA requests as needed.

Clinical Knowledge

• Maintain professional and technical knowledge of:
• Drug therapies
• Disease states
• Specialty Pharmacy
• Non-Specialty Pharmacy
• Clinical criteria
• Prior Authorization procedures

Required Qualifications

• Bachelor's degree in Pharmacy / BS Pharmacy
• Active Pharmacist license in good standing in the state of residence/practice
• 1+ year of pharmacist experience required
• Strong computer skills
• Strong organizational skills
• Excellent attention to detail
• Strong written and verbal communication skills
• Ability to work independently in a remote environment
• Ability to manage a high-volume workload
• Ability to make clinical determinations using established criteria and procedures

Preferred Qualifications

• 2+ years of Prior Authorization review experience
• Previous PBM experience
• Managed Care experience
• Health Plan experience
• Specialty Pharmacy experience
• Prior experience reviewing Specialty Pharmacy prior authorizations
• Experience communicating PA determinations to physicians, providers, or members
• Experience working with high-volume PA cases
• Previous remote work experience

Ideal Candidate Profile

The ideal candidate will have:

• Active pharmacist license
• 2+ years of Prior Authorization experience
• PBM, Managed Care, or Health Plan experience
• Specialty Pharmacy experience
• Strong clinical review skills
• Experience handling high-volume prior authorization workloads
• Ability to manage approximately 40 PA cases per day
• Comfort with approximately 50 inbound/outbound calls per day
• Strong provider communication skills
• Strong documentation skills
• Excellent attention to detail
• Ability to work independently and meet productivity expectations
• Ability to work one weekend day each week
• Availability for the entire training period

Remote Work Requirements

This is a fully remote position.

Candidates must provide their own high-speed internet and meet the following minimum requirements:

• 25 Mbps download
• 3 Mbps upload
• Reliable broadband connection
• Smartphone capable of downloading the required VPN token
• Dedicated, quiet and private workspace
• Stable living accommodations suitable for remote work

Internet Speed Test — REQUIRED

Candidates must complete an internet speed test through:

Speedtest.net

The following must be clearly visible:

• Internet provider
• Download speed
• Upload speed

A screenshot of the speed test MUST be placed at the top of the resume.

Pharmacist License — REQUIRED

An active pharmacist license in the candidate's state of residence is required.

The resume must include:

• Pharmacist name
• License state
• License number
• Expiration date
• Current/active status

A screenshot of the active pharmacist license MUST be placed at the top of the resume.

Work-From-Home Requirements

Candidates must:

• Have a dedicated private workspace with a door.
• Maintain a quiet work environment.
• Be able to work without interruptions during scheduled hours.
• Protect CVS Health equipment and confidential information.
• Ensure computer screens and documents cannot be viewed by others.
• Ensure work-related conversations cannot be overheard.
• Secure equipment and information against unauthorized access or theft.
• Lock the workstation or shut down the computer when stepping away.
• Shut down the computer when the workday is complete.
• Follow all applicable Teleworker Privacy Practices.

Candidate Questionnaire

The completed questionnaire must be included with the submission and reviewed with the candidate.

• What state(s) do you currently hold an active Pharmacist license in?
• How many years of Pharmacist experience do you have?
• How many years of Prior Authorization experience do you have?
• Please describe your PBM, Managed Care, or Health Plan experience.
• Have you reviewed Specialty Pharmacy Prior Authorizations? If yes, please specify the therapeutic areas.
• What pharmacy systems and platforms have you used?
• Examples: Caremark, RxClaim, Facets, GuidingCare, etc.
• Approximately how many Prior Authorization reviews did you complete daily in your most recent role?
• Have you communicated PA determinations directly with physicians, providers, or members? Please explain.
• Do you have a private workspace in your home with a door?
• Can you attend training from November 9–December 4, 2026, Monday–Friday, 8:00 AM–4:30 PM CST, and work the assigned schedule following training?

Training is mandatory.

Training Dates: November 9–December 4, 2026

Training Schedule:
Monday–Friday
8:00 AM–4:30 PM CST

Candidates must be available for the entire training period.

Following training, candidates will be placed into a set schedule based on business needs.

Available Post-Training Schedules

Candidates must be available for one of the following schedules:

Sunday–Thursday OR Tuesday–Saturday

Available shifts:

• 10:30 AM–7:00 PM CST
• 11:00 AM–7:30 PM CST
• 11:30 AM–8:00 PM CST

Candidates should be comfortable working one weekend day each week.

Important Hiring Information

• Start Date: November 9, 2026
• Offer Extended By: October 12, 2026
• Offer Acceptance By: October 15, 2026
• Must Clear Prior To: October 30, 2026
• Excluded States: New Mexico and Colorado

INDJP

Remote Pharmacist – Prior Authorization

Fully Remote

A-Line Staffing is hiring Registered Pharmacists for a fully remote Prior Authorization opportunity supporting Commercial Specialty and Non-Specialty Pharmacy programs.

This position is ideal for an experienced pharmacist with Prior Authorization, PBM, Managed Care, Health Plan, Specialty Pharmacy, or clinical review experience who is comfortable performing high-volume clinical reviews and communicating with providers, physicians, members, and internal pharmacy teams.

Opportunity for full-time employment contingent on performance.

Position Details

• Position: Pharmacist/Clinician – Prior Authorization
• Job Type: Full-Time
• Work Arrangement: Fully Remote – Never Onsite
• Excluded States: New Mexico and Colorado
• Start Date: November 9, 2026
• Schedule: Sun–Thurs OR Tues–Sat
• Available Shifts:
• 10:30 AM–7:00 PM CST
• 11:00 AM–7:30 PM CST
• 11:30 AM–8:00 PM CST
• Training: November 9–December 4, 2026
• Training Schedule: Monday–Friday, 8:00 AM–4:30 PM CST

Position Summary

The Pharmacist/Clinician is responsible for conducting criteria-based and clinical review of prior authorization requests in accordance with established policies and procedures.

The pharmacist will evaluate clinical information, verify coverage and eligibility, interpret clinical criteria and plan requirements, and render appropriate coverage determinations.

The position also involves working closely with prior authorization technicians and other team members, answering clinical questions, collecting additional clinical information, and conducting inbound and outbound calls with physicians, healthcare providers, patients, and internal teams.

Key Responsibilities

Prior Authorization & Clinical Review

• Evaluate and review prior authorization requests.
• Render coverage determinations based on clinical criteria and plan design.
• Verify insurance coverage and eligibility.
• Interpret applicable clinical guidelines and criteria.
• Apply clinical knowledge and appropriate pharmacy resources when reviewing cases.
• Consult with physicians and other healthcare providers as needed.
• Ensure decisions are processed and communicated promptly according to established approval and denial procedures.
• Review both Specialty and Non-Specialty Pharmacy prior authorization requests.

Provider & Member Communication

• Conduct inbound and outbound calls with:
• Physicians
• Healthcare providers
• Patients/members
• Prior authorization team members
• Pharmacy technicians
• Answer clinical questions related to prior authorization requests.
• Obtain additional clinical or medical information needed to complete reviews.
• Resolve escalations appropriately.
• Communicate approval and denial determinations according to established procedures.

Team Collaboration

• Collaborate with technicians and prior authorization team members to process referrals.
• Provide clinical support to the Prior Authorization team.
• Support Member Services with clinical questions when appropriate.
• Participate in training sessions, development meetings, and other assigned projects.
• Provide on-call or after-hours pharmacist availability for urgent PA requests as needed.

Clinical Knowledge

• Maintain professional and technical knowledge of:
• Drug therapies
• Disease states
• Specialty Pharmacy
• Non-Specialty Pharmacy
• Clinical criteria
• Prior Authorization procedures

Required Qualifications

• Bachelor's degree in Pharmacy / BS Pharmacy
• Active Pharmacist license in good standing in the state of residence/practice
• 1+ year of pharmacist experience required
• Strong computer skills
• Strong organizational skills
• Excellent attention to detail
• Strong written and verbal communication skills
• Ability to work independently in a remote environment
• Ability to manage a high-volume workload
• Ability to make clinical determinations using established criteria and procedures

Preferred Qualifications

• 2+ years of Prior Authorization review experience
• Previous PBM experience
• Managed Care experience
• Health Plan experience
• Specialty Pharmacy experience
• Prior experience reviewing Specialty Pharmacy prior authorizations
• Experience communicating PA determinations to physicians, providers, or members
• Experience working with high-volume PA cases
• Previous remote work experience

Ideal Candidate Profile

The ideal candidate will have:

• Active pharmacist license
• 2+ years of Prior Authorization experience
• PBM, Managed Care, or Health Plan experience
• Specialty Pharmacy experience
• Strong clinical review skills
• Experience handling high-volume prior authorization workloads
• Ability to manage approximately 40 PA cases per day
• Comfort with approximately 50 inbound/outbound calls per day
• Strong provider communication skills
• Strong documentation skills
• Excellent attention to detail
• Ability to work independently and meet productivity expectations
• Ability to work one weekend day each week
• Availability for the entire training period

Remote Work Requirements

This is a fully remote position.

Candidates must provide their own high-speed internet and meet the following minimum requirements:

• 25 Mbps download
• 3 Mbps upload
• Reliable broadband connection
• Smartphone capable of downloading the required VPN token
• Dedicated, quiet and private workspace
• Stable living accommodations suitable for remote work

Internet Speed Test — REQUIRED

Candidates must complete an internet speed test through:

Speedtest.net

The following must be clearly visible:

• Internet provider
• Download speed
• Upload speed

A screenshot of the speed test MUST be placed at the top of the resume.

Pharmacist License — REQUIRED

An active pharmacist license in the candidate's state of residence is required.

The resume must include:

• Pharmacist name
• License state
• License number
• Expiration date
• Current/active status

A screenshot of the active pharmacist license MUST be placed at the top of the resume.

Work-From-Home Requirements

Candidates must:

• Have a dedicated private workspace with a door.
• Maintain a quiet work environment.
• Be able to work without interruptions during scheduled hours.
• Protect CVS Health equipment and confidential information.
• Ensure computer screens and documents cannot be viewed by others.
• Ensure work-related conversations cannot be overheard.
• Secure equipment and information against unauthorized access or theft.
• Lock the workstation or shut down the computer when stepping away.
• Shut down the computer when the workday is complete.
• Follow all applicable Teleworker Privacy Practices.

Candidate Questionnaire

The completed questionnaire must be included with the submission and reviewed with the candidate.

• What state(s) do you currently hold an active Pharmacist license in?
• How many years of Pharmacist experience do you have?
• How many years of Prior Authorization experience do you have?
• Please describe your PBM, Managed Care, or Health Plan experience.
• Have you reviewed Specialty Pharmacy Prior Authorizations? If yes, please specify the therapeutic areas.
• What pharmacy systems and platforms have you used?
• Examples: Caremark, RxClaim, Facets, GuidingCare, etc.
• Approximately how many Prior Authorization reviews did you complete daily in your most recent role?
• Have you communicated PA determinations directly with physicians, providers, or members? Please explain.
• Do you have a private workspace in your home with a door?
• Can you attend training from November 9–December 4, 2026, Monday–Friday, 8:00 AM–4:30 PM CST, and work the assigned schedule following training?

Training is mandatory.

Training Dates: November 9–December 4, 2026

Training Schedule:
Monday–Friday
8:00 AM–4:30 PM CST

Candidates must be available for the entire training period.

Following training, candidates will be placed into a set schedule based on business needs.

Available Post-Training Schedules

Candidates must be available for one of the following schedules:

Sunday–Thursday OR Tuesday–Saturday

Available shifts:

• 10:30 AM–7:00 PM CST
• 11:00 AM–7:30 PM CST
• 11:30 AM–8:00 PM CST

Candidates should be comfortable working one weekend day each week.

Important Hiring Information

• Start Date: November 9, 2026
• Offer Extended By: October 12, 2026
• Offer Acceptance By: October 15, 2026
• Must Clear Prior To: October 30, 2026
• Excluded States: New Mexico and Colorado

INDJP