Prior Authorization Pharmacist (Remote)

About the role

We are looking for a licensed Prior Authorization Pharmacist to join our expanding Pharmacy Benefit Management (PBM) team. This remote position involves reviewing medication prior‑authorization requests, applying clinical guidelines and evidence‑based criteria, and delivering timely coverage decisions while ensuring regulatory compliance.

Key responsibilities

• Review and evaluate prior‑authorization requests for formulary and non‑formulary medications using clinical guidelines, FDA indications, and utilization‑management criteria.
• Make timely approval, denial, or modification decisions within established turnaround times and pharmacy licensure requirements.
• Document clinical decisions, rationale, and case activity accurately in pharmacy systems.
• Communicate determinations to providers, pharmacies, and internal stakeholders.
• Recommend clinically appropriate alternatives, step‑therapy options, or cost‑effective therapies when applicable.
• Collaborate with Clinical Services and operational teams to ensure consistent, high‑quality decision‑making.
• Provide clinical guidance on escalated medication and benefit‑related inquiries.
• Maintain compliance with federal and state regulations, accreditation standards, and internal policies.
• Participate in formulary management, clinical policy reviews, and utilization‑management initiatives.
• Support quality‑assurance activities, audits, staff training, and continuous process‑improvement efforts.

Required profile

• Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy from an accredited institution.
• Active, unrestricted U.S. pharmacist license.
• Minimum of 3 years prior‑authorization experience in a PBM or Managed Care environment.
• Experience using pharmacy benefit systems, prior‑authorization platforms, and electronic documentation systems.

Required skills

• Pharmacy benefit systems
• Prior‑authorization platforms
• Electronic documentation systems