Date Posted: 08/26/2026
Hiring Organization: Rose International
Position Number: 506347
Industry: Pharmaceutical/Healthcare
Job Title: Pharmacist Prior Authorization Clinical Review
Job Location: Remote, USA
Work Model: Remote
Shift:
Sun to Thurs or Tues to Sat
10:30 am-7 pm CST
11 am-7:30 pm CST
11:30 am-8 pm CST
Employment Type: Temporary
FT/PT: Full-Time
Estimated Duration (In months): 11
Min Hourly Rate($): 51.00
Max Hourly Rate($): 53.00
Must Have Skills/Attributes: Computer Literacy, Interpersonal Skills, Pharmacy
Experience Desired: Prior work experience as a pharmacist (1-3 yrs); Prior authorization experience (2 yrs); Ability to handle inbound and outbound calls and resolve escalations (3 yrs)
Required Minimum Education: Bachelor’s Degree
Preferred Education: Ph.D / Doctorate
Required Certifications/Licenses: Active pharmacist license in the state of residence
**C2C is not available**
Job Description
Required Education
• Bachelor’s degree in pharmacy (BS Pharmacy)
Preferred Education
• Doctorate in Pharmacy (PharmD)
Required License/Certification
• Active pharmacist license in the state of residence
Required Qualifications/Skills/Experience
• 1–3 years of prior work experience as a pharmacist
• 2 years in prior authorization
• Ability to evaluate and review prior authorization requests using clinical criteria and plan design
• Ability to interpret clinical guideline criteria and apply clinical knowledge and resources appropriately
• Ability to collaborate with physicians, healthcare providers, technicians, prior authorization team members, patients, health plans, and employers
• Ability to collect and evaluate appropriate clinical and medical data
• Ability to handle inbound and outbound calls and resolve escalations
• Ability to meet designated service level agreements (SLAs)
• Ability to comply with department protocols and approval and denial management processes
• Basic computer skills
Preferred Qualifications/Skills/Experience
• 3–5 years of prior work experience in prior authorization
• Previous pharmacy experience in a pharmacy benefit manager (PBM) environment
• Knowledge of drug and disease states for Specialty and Non-Specialty Pharmacy programs
Pharmacist Overview
• The Pharmacist/Clinician is an operations-based role responsible for conducting criteria-based and clinical reviews of medical data to perform prior authorization determinations in accordance with established policies and procedures
• Applies clinical knowledge and approved criteria to review cases and make appropriate coverage determinations
• Works within supported pharmacy and clinical systems to review pending prior authorizations and communicate with physicians, healthcare providers, and members regarding approved or denied requests
• Collaborates with the Prior Authorization team and Member Services to answer clinical questions, obtain necessary medical information, and resolve escalations
• Maintains professional and technical knowledge of drug and disease states across Specialty and Non-Specialty Pharmacy programs
• Provides on-call and after-hours pharmacist availability for urgent prior authorization requests as needed
Job Duties
• Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design
• Verify insurance coverage and eligibility and interpret applicable clinical guideline criteria
• Consult with physicians and other healthcare providers as needed and appropriately utilize clinical knowledge and resources while complying with department protocols
• Communicate case decisions promptly and efficiently to healthcare providers, health plans/employers, patients, and other healthcare professionals in accordance with established approval and denial management processes
• Collaborate with technicians and Prior Authorization team members to process referrals
• Answer clinical questions and collect appropriate clinical and medical data needed to perform clinical assessments and reviews according to health plan/employer-agreed criteria and designated SLAs
• Handle inbound and outbound phone calls with technicians, Prior Authorization team members, physicians, healthcare providers, and patients to facilitate prior authorization requests, answer inquiries, and resolve escalations
• Maintain professional and technical knowledge of drug and disease states for Specialty and Non-Specialty Pharmacy programs administered within the Commercial Specialty line of business
• Attend training sessions and development meetings
• Provide on-call and after-hours pharmacist availability as needed - **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.**
Benefits:
For information and details on employment benefits offered with this position, please visit here. Should you have any questions/concerns, please contact our HR Department via our secure website.
California Pay Equity:
For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations' website here.
Rose International is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender (expression or identity), national origin, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances.
If you need assistance in completing this application, or during any phase of the application, interview, hiring, or employment process, whether due to a disability or otherwise, please contact our HR Department.
Rose International has an official agreement (ID #132522), effective June 30, 2008, with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). (Posting required by OCGA 13/10-91.).
Working for Rose International was the most pleasant assignment I have ever had. They were always on top of situations when necessary, and very helpful. I was very proud to be an employee of Rose International, and would recommend anyone to try to work with them.
Melvon, Consultant
Thanks for the opportunity. If in the future I ever need a job, I would like to work for Rose International.
David, Consultant
I believe the best thing that Rose HR has going for it is the incredible responsiveness. Everyone is very quick to reply to any concerns, and contacts the contracted employees very quickly and efficiently.
Kevin, Consultant
Rose International has been great to me. I thank everyone there for all of their hard work; it has not gone unnoticed.
Melody, Consultant
Rose International maintained good communication during assignments and are very informative through email and phone calls.
Sade, Consultant
EMPLOYEE COMMENTS