Clinical Pharmacist

VIVA; United States; Remote; USD 110,000 - 150,000; Full time

Job summary

VIVA USA Inc. is hiring a Prior Authorization Pharmacist for a fully remote role.

You will review and adjudicate medication prior authorization requests, applying evidence-based guidelines, FDA labeling, and plan-specific criteria to ensure medical necessity and formulary compliance while balancing utilization objectives. The position requires an active AZ or TX license, 3+ years of pharmacist experience, and strong collaboration with clinical staff to resolve complex cases.

Qualifications

• Active and unrestricted AZ or TX pharmacist license.
• Experience applying evidence-based guidelines and formulary/criteria.
• Experience in high production team environment.

Responsibilities

• Review and adjudicate prior authorization requests for medical necessity and formulary compliance.
• Apply guidelines, drug compendia, FDA labeling, and plan-specific criteria.
• Evaluate patient factors and justify decisions with clinical rationale.
• Authorize, modify, or deny requests and document rationale clearly.
• Collaborate with technicians, nurses, medical directors and staff on complex cases.
• Support peer-to-peer reviews and prepare clinical summaries when escalation is required.
• Ensure compliance with regulations, accreditation standards, and internal audits.
• Maintain productivity, turnaround time, and quality benchmarks for processing.

Skills

AZ/TX license

Clinical decision-making

High production team experience

3+ years pharmacist experience

Formulary knowledge/benefit trends

Education

PharmD or Pharm D equivalent

Active license in good standing

Job description

Fully remote (never coming onsite)

Position Summary

The Prior Authorization Pharmacist is responsible for reviewing and evaluating medication prior authorization requests to ensure appropriate, safe, and cost-effective therapy in accordance with clinical guidelines, regulatory requirements, and organizational policies. This role applies clinical judgement to support optimal patient outcomes while balancing utilization management objectives.

Duties

• Review, assess, adjudicate medication prior authorization requests for medical necessity, clinical appropriateness, and formulary compliance.
• Apply evidence-based clinical guidelines, drug compendia, FDA labeling, and plan-specific criteria to authorization decisions.
• Evaluate patient-specific factors including diagnosis, laboratory results, prior therapy, dosing, contraindications, and comorbid conditions.
• Authorize, modify, or deny medication requests and document clinical rationale clearly and accurately.
• Collaborate with pharmacy technicians, nurses, medical directors, and other clinical staff to resolve complex cases.
• Support peer-to-peer reviews and prepare clinical summaries when escalation is required.
• Ensure compliance with state and federal regulations, accreditation standards (e.g. NCQA, URAC), and internal audit requirements.
• Maintain productivity, turnaround time, and quality benchmarks for prior authorization processing.
• Document all activities accurately within prior authorization and pharmacy management systems.

Experience

• Active and unrestricted AZ or TX pharmacist license.
• Experience with clinical decision-making while applying evidence based clinical guidelines/criteria; utilizing formularies/preferred drug lists.
• Experience working in a high production team environment.
• 3+ years experience working as a pharmacist.
• Knowledge of clinical program components, formulary designs, and prescription benefit trends.

Education

• High School Diploma or GED required. Bachelor's degree in pharmacy or Pharm D. also required with at least two years experience as a pharmacist. Must have an active license in good standing.
• An active AZ or TX pharmacist license that is in good standing is required.

Notes:

• Fully remote (never coming onsite)
• Must be ok with these hours (AZ time zone)
• We are hiring for the Monday-Fri from 10:00 am - 6:30 pm shift AZ time (post training).
• The training schedule is: 8:00 am - 4:30 pm AZ time (-8 weeks).

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status