Job Description
Job Description Remote Prior Authorization Pharmacist (Pharmacist - Prior Auth) Location: Remote (continental U.S.;
not available in New Mexico or Colorado )
Schedule: Full-time |
Sun-Thurs or Tues-Sat (CST shifts)
Shift Options (CST): 10:30am-7:00pm | 11:00am-7:30pm | 11:30am-8:00pm
Training: Nov 9-Dec 4 | Mon-Fri 8:00am-4:30pm CST (mandatory)
Pay: $53.00/hour
Summary Hiring a
Remote Pharmacist to complete
criteria-based prior authorization (PA) reviews and issue coverage determinations for specialty and non-specialty pharmacy programs. This is a great fit for pharmacists with
PBM / managed care / health plan experience who are comfortable working high-volume cases, communicating determinations, and documenting accurately in multiple systems. If you're searching for
remote pharmacist jobs ,
prior authorization pharmacist ,
PBM pharmacist , or
managed care pharmacist roles-this opportunity offers structured training and consistent schedules.
Responsibilities - Review prior authorization requests and render coverage determinations using clinical criteria and plan design
- Verify insurance eligibility/coverage; interpret clinical guideline criteria
- Consult with providers as needed; communicate approvals/denials promptly and professionally
- Collaborate with technicians and PA team members to gather required clinical documentation
- Handle inbound/outbound calls with providers/members/PA team to resolve escalations and answer questions
- Maintain current knowledge of drug and disease states for specialty and non-specialty therapies
- Document all activity clearly and accurately while meeting service level expectations
Remote Prior Authorization Pharmacist (Pharmacist - Prior Auth) Location: Remote (continental U.S.;
not available in New Mexico or Colorado )
Schedule: Full-time |
Sun-Thurs or Tues-Sat (CST shifts)
Shift Options (CST): 10:30am-7:00pm | 11:00am-7:30pm | 11:30am-8:00pm
Training: Nov 9-Dec 4 | Mon-Fri 8:00am-4:30pm CST (mandatory)
Pay: $53.00/hour
Summary Hiring a
Remote Pharmacist to complete
criteria-based prior authorization (PA) reviews and issue coverage determinations for specialty and non-specialty pharmacy programs. This is a great fit for pharmacists with
PBM / managed care / health plan experience who are comfortable working high-volume cases, communicating determinations, and documenting accurately in multiple systems. If you're searching for
remote pharmacist jobs ,
prior authorization pharmacist ,
PBM pharmacist , or
managed care pharmacist roles-this opportunity offers structured training and consistent schedules.
Responsibilities - Review prior authorization requests and render coverage determinations using clinical criteria and plan design
- Verify insurance eligibility/coverage; interpret clinical guideline criteria
- Consult with providers as needed; communicate approvals/denials promptly and professionally
- Collaborate with technicians and PA team members to gather required clinical documentation
- Handle inbound/outbound calls with providers/members/PA team to resolve escalations and answer questions
- Maintain current knowledge of drug and disease states for specialty and non-specialty therapies
- Document all activity clearly and accurately while meeting service level expectations
Qualifications - Active Pharmacist license (unrestricted; in good standing)
- Prior authorization review experience (PBM / managed care / health plan strongly preferred)
- Strong clinical judgment, documentation skills, and attention to detail
- Professional phone presence; comfortable with provider outreach and high-volume workflows
- Able to work in a secure home office and maintain confidentiality (HIPAA/privacy standards)
- Reliable high-speed internet ( min 25 Mbps download / 3 Mbps upload ) and a smartphone (VPN token required)
- Dedicated private workspace; hard requirement to complete training and assigned schedule
Job Requirements Qualifications - Active Pharmacist license (unrestricted; in good standing)
- Prior authorization review experience (PBM / managed care / health plan strongly preferred)
- Strong clinical judgment, documentation skills, and attention to detail
- Professional phone presence; comfortable with provider outreach and high-volume workflows
- Able to work in a secure home office and maintain confidentiality (HIPAA/privacy standards)
- Reliable high-speed internet ( min 25 Mbps download / 3 Mbps upload ) and a smartphone (VPN token required)
- Dedicated private workspace; hard requirement to complete training and assigned schedule
Meet Your Recruiter Holly Romain
hromain@alinestaffing.com
hromain@alinestaffing.com
About Woonsocket, RI Explore exciting job opportunities near Woonsocket, Rhode Island! Nestled in the picturesque New England region, Woonsocket offers a charming blend of historic charm and modern opportunities. With landmarks like the stunning Museum of Work & Culture, vibrant arts scene at the Stadium Theatre Performing Arts Centre, and delectable cuisine options ranging from classic clam bakes to trendy food trucks, this area promises a fulfilling career and a quality lifestyle. Join the proud community supporting local teams like the Pawtucket Red Sox at McCoy Stadium and savor outdoor adventures at the scenic World War II Veterans Memorial Park. Start your professional journey in Woonsocket, where every day offers a new chapter of growth and success.
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Job Tags
Full time, Local area, Work from home, Home office, Shift work