Remote Clinical Pharmacist – Prior Authorization Specialist

About the role

We are seeking a Remote Clinical Pharmacist to support our prior authorization and appeal program. You will evaluate clinical documentation, make coverage determinations, and collaborate with prescribers, pharmacies, and internal teams to ensure accurate, compliant decisions.

Key responsibilities

• Review clinical documentation and determine coverage eligibility based on established criteria.
• Gather necessary clinical information by communicating with prescribers, pharmacies, and internal stakeholders.
• Document decisions and communicate outcomes clearly and promptly.
• Maintain compliance with regulatory, client, and payer requirements.
• Identify and implement process improvements within the prior authorization workflow.

Required profile

• Active pharmacist license in your state of residence (PharmD required).
• Prior experience conducting prior authorization reviews.
• Ability to manage multiple high‑priority tasks in a production‑driven environment.
• Strong attention to detail and commitment to accuracy.
• Excellent verbal, written, and interpersonal communication skills.

Required skills

• Experience with multiple PBM platforms and payer‑specific prior authorization workflows.
• Familiarity with medical vs. pharmacy benefit coverage determinations.
• Exposure to appeals processing (first‑level, second‑level, or external review).
• Working knowledge of managed care, utilization management, and health‑plan operations.
• Comfort reviewing specialty medications such as biologics, oncology, and rare‑disease therapies.
• Understanding of CMS, state, and payer regulatory requirements.
• Proficiency with workflow, ticketing, or case‑management systems for clinical reviews.

What we offer

• 100% work‑from‑home arrangement.
• Contract position based out of Birmingham, AL.
• Pay range $50.00 – $55.00 per hour.
• Potential benefits include medical, dental, vision, critical illness, accident, hospital coverage, and a 401(k) retirement plan.