NEW JOB OPENING
REMOTE CLINICAL PHARMACIST-PRIOR AUTHORIZATION
IN Remote, USA!

Required Education:

• Bachelor’s degree in pharmacy



Preferred Education:

• Doctor of Pharmacy (PharmD)



Required License/Certification:

• Active Pharmacist license in the applicable state of practice or residence



Required Qualifications/Skills/Experience:

• 1–3 years of previous pharmacy experience

• Prior authorization review experience

• Basic computer skills

• Strong organizational skills

• Strong interpersonal and communication skills

• Strong attention to detail

• Ability to review clinical documentation and apply clinical criteria

• Ability to evaluate medical necessity and render coverage determinations

• Ability to verify insurance coverage and eligibility

• Ability to interpret clinical guideline criteria and plan design

• Ability to communicate determinations promptly and accurately

• Ability to manage approximately 40 prior authorization cases per day

• Ability to manage approximately 50 inbound and outbound calls per day

• Ability to work remotely with a private, secure workspace

• Ability to provide personal high-speed internet

• Minimum internet speed of 25 Mbps download and 3 Mbps upload

• Smartphone required for VPN token access

• Ability to work one weekend day each week

• Ability to attend the complete training period

• Ability to work the assigned schedule after training



Preferred Qualifications/Skills/Experience:

• 3–5 years of previous pharmacy experience

• PBM experience

• Managed Care or Health Plan experience

• Specialty Pharmacy experience

• Experience reviewing Specialty Pharmacy prior authorizations

• Experience with pharmacy systems and platforms such as Caremark, RxClaim, Facets, or GuidingCare

• Experience communicating prior authorization determinations directly with physicians, providers, or members

• Previous remote work experience



Remote Clinical Pharmacist – Prior Authorization Overview:

• The Remote Prior Authorization Pharmacist is responsible for conducting criteria-based and clinical reviews of medical information to support prior authorization decisions in accordance with established policies, procedures, and plan requirements

• This position applies clinical knowledge and approved criteria to evaluate prior authorization requests, assess medical necessity, verify coverage and eligibility, and render appropriate coverage determinations

• The role involves reviewing specialty and non-specialty pharmacy cases, interpreting clinical guidelines, consulting with physicians and healthcare providers, and communicating approval or denial decisions in a timely and accurate manner

• The Pharmacist/Clinician will work within client-supported pharmacy systems, respond to inbound calls from providers or members regarding pending, approved, or denied requests, and provide internal support to prior authorization and member services teams

• The position also requires collaboration with technicians and other clinical team members, participation in training and development activities, and potential on-call or after-hours availability for urgent prior authorization requests



Job Duties:

• Evaluate and review prior authorization requests and render coverage determinations based on clinical criteria and plan design

• Verify insurance coverage and member eligibility

• Interpret clinical guideline criteria and apply clinical knowledge and available resources

• Consult with physicians and other healthcare providers regarding clinical reviews

• Communicate case decisions promptly and efficiently to healthcare providers, health plans, employers, patients, and other healthcare professionals

• Follow established approval and denial management processes

• Collaborate with pharmacy technicians and prior authorization team members to process referrals

• Answer clinical questions and collect appropriate clinical and medical information needed to complete assessments and reviews

• Conduct inbound and outbound calls with technicians, prior authorization team members, physicians, healthcare providers, and patients

• Facilitate prior authorization requests and respond to inquiries

• Resolve escalated issues related to prior authorization cases

• Maintain professional and technical knowledge of drug and disease states for specialty and non-specialty pharmacy programs

• Attend training sessions and development meetings

• Provide on-call and after-hours pharmacist availability for urgent prior authorization requests, as needed

• Perform other related duties and projects as assigned



#CV1

• **Only those lawfully authorized to work in the designated country associated with the position will be considered.**

• **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.**