*Clinical Pharmacist - Prior Authorization

Lancesoft; Woonsocket (RI); Remote; USD 87,000 - 91,000; Full time

Benefits offered by this job

Medical Insurance

Dental and Vision Insurance

401k Contributions

Critical Illness Insurance

Voluntary Permanent Life Insurance

Accident Insurance

Other Employee Perks

Job summary

LanceSoft is seeking a Prior Authorization Pharmacist for a remote, temporary opportunity. The role requires reviewing and adjudicating prior authorization requests, applying guidelines and plan criteria, and collaborating with clinical staff to achieve appropriate, cost-effective therapy.

The position requires an AZ or TX pharmacist license, 3+ years of pharmacist experience, and a PharmD or PharmD-equivalent degree. Comprehensive benefits and a focus on compliance are provided.

Qualifications

• Active and unrestricted AZ or TX pharmacist license.
• Experience applying evidence-based clinical guidelines and formulary criteria.
• Experience in a high-production pharmacist environment.
• 3+ years of experience as a pharmacist.
• Knowledge of clinical program components, formulary designs, and prescription benefit trends.

Responsibilities

• Review, adjudicate, and authorize or deny medication prior authorization requests based on medical necessity and formulary compliance.
• Apply clinical guidelines, drug references, FDA labeling, and plan-specific criteria to decisions.
• Evaluate patient-specific factors such as diagnosis, labs, prior therapy, dosing, and contraindications.
• Document rationale clearly and accurately; maintain documentation in systems.
• Collaborate with technicians, nurses, medical directors, and other staff to resolve complex cases.
• Support peer-to-peer reviews and prepare summaries for escalation when needed.
• Ensure compliance with state/federal regulations and accreditation standards.
• Maintain productivity, turnaround time, and quality benchmarks for processing.
• Document all activities in prior authorization and pharmacy management systems.

Skills

AZ license

TX license

Education

Bachelor's degree in pharmacy

Pharm D

Job description

Job ID: 26-149800

Position Type: Temporary

Location: Remote

Work Type: Fulltime

Est. Pay Range: $63.00/hr. To $65.75/hr.

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

• 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.

Employee Benefits

• Four options of medical Insurance
• Dental and Vision Insurance
• 401k Contributions
• Critical Illness Insurance
• Voluntary Permanent Life Insurance
• Accident Insurance
• Other Employee Perks

LanceSoft is a certified Minority Business Enterprise (MBE) and an equal opportunity employer. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. LanceSoft makes hiring decisions based solely on qualifications, merit, and business needs at the time.