Remote Clinical Review Pharmacist

About the role

The Clinical Review Pharmacist works remotely to process and document Utilization Management (UM) requests such as prior authorizations, step therapy, and formulary exceptions for delegated products and services. The role supports both Medicare and Commercial lines, requiring detailed clinical judgment and clear communication with providers.

Key responsibilities

• Evaluate and determine client UM requests, reviewing denial language and program criteria.
• Provide direct consultation to health‑care providers on non‑formulary and coverage issues.
• Collaborate with fellow pharmacists to ensure consistent clinical decisions across the team.
• Perform additional duties as assigned.

Required profile

• Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy.
• Current pharmacist license in good standing with the state board.
• Ability to make independent clinical decisions and prioritize multiple projects.
• Self‑starter who thrives without constant direction.
• Flexibility to adapt in a dynamic environment.
• Comfort with learning new computer systems and using multiple monitors.

Required skills

What we offer

• Competitive hourly rate of $55‑$60.
• Fully remote work arrangement.