Prior Authorization Pharmacist - 234071

Medix™; United States; On-site; USD 112,500 - 137,500; Full time

Benefits offered by this job

Flexible work environment

Competitive salary

Contract-to-hire opportunity

Job summary

A healthcare staffing agency is seeking a PBM/Prior Authorization Review Pharmacist for a remote position. The role entails reviewing prior authorization requests, ensuring compliance with regulations, and supporting clinical programs. Ideal candidates will have a pharmacy degree and experience in managed care. This contract-to-hire role provides a chance for long-term placement based on performance.

Qualifications

• Minimum of 2 years of pharmacy practice experience.
• Experience in managed care or pharmacy benefit management (PBM).
• Availability to work after hours, weekends, and holidays on a rotating schedule.

Responsibilities

• Review and make timely, evidence-based decisions on prior authorizations.
• Ensure compliance with regulations across various health plans.
• Document clinical decisions in accordance with regulatory standards.

Skills

Communication skills

Organizational skills

Ability to manage multiple priorities

Education

Bachelor’s or Doctor of Pharmacy degree

Job description

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Direct message the job poster from Medix

We are seeking a PBM/Prior Authorization Review Pharmacist to join our team on a remote basis. This role is responsible for reviewing prior authorization requests, supporting clinical programs, and providing expert guidance to members, providers, and pharmacies. You will combine clinical decision-making with a focus on service excellence in a collaborative, fast-paced environment.

Please note - We are looking for individuals for a second/mid shift. Additionally, this role is a Contract-to-Hire model. Candidates must be open to contract-to-hire, with potential for long-term placement based on business needs and performance. This is not guaranteed.

Position Responsibilities:

• Review and make timely, evidence-based decisions on prior authorizations, appeals, and override requests using clinical guidelines and benefit criteria.
• Ensure compliance with federal, state, and internal regulations across Commercial, Exchange, Medicare, and Medicaid plans.
• Accurately document clinical decisions and maintain thorough records in accordance with regulatory and accreditation standards (URAC/NCQA).
• Respond to clinical inquiries from members, prescribers, and pharmacies with professionalism, active listening, and a patient-centered approach.
• Stay current with clinical prescribing guidelines, internal policies, and regulatory changes, and apply them to daily responsibilities.
• Follow all internal procedures, job aids, and HIPAA guidelines to protect patient privacy and data security.
• Identify and report potential fraud, waste, and abuse.
• Support training and development of new and existing team members.
• Assist leadership with special projects, process improvements, and operational initiatives.

Minimum Qualifications:

• Bachelor’s or Doctor of Pharmacy degree
• Minimum of 2 years of pharmacy practice experience
• Experience in managed care or pharmacy benefit management (PBM)
• Strong communication, writing, and organizational skills
• Ability to manage multiple priorities in a high-volume, metric-driven environment
• Availability to work after hours, weekends, and holidays on a rotating schedule

Preferred Qualifications:

• Call center experience

Salary and Benefits:

• Salary: $125,000 USD per year
• Flexible Work Environment: Remote opportunities available
• Contract-to-Hire: Open to contract-to-hire, with potential for long-term placement based on business needs and performance.

Why Join Us?

• Innovative and Impactful Work: Be part of a company focused on transforming the healthcare industry for the better.
• Collaborative and Inclusive Culture: We value diversity and believe in supporting each other’s growth and development.
• Competitive Compensation: Competitive salary, with a commitment to career development and growth.

How to Apply:

If you're passionate about making a meaningful impact on healthcare and meet the qualifications, we encourage you to apply today. Become part of our team and help us re imagine the future of healthcare!

Seniority level

• Seniority level

  Not Applicable

Employment type

• Employment type

  Contract

Job function

• Job function

  Health Care Provider

• Industries

  Staffing and Recruiting

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Inferred from the description for this job

Medical insurance

Vision insurance

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