Clinical Pharmacist (RPh) - Prior Authorization & Formulary Operations (Remote)

Medix; Seattle (WA); Remoto; USD 96.000 - 110.000; Tempo pieno

Descrizione del lavoro

Medix Staffing Solutions, Inc. is seeking a licensed Clinical Pharmacist (RPh) for a contract-to-hire opportunity supporting virtual pharmacy benefit operations.

This role involves high-volume first-level coverage determinations for prescription drug requests using established guidelines and formulary criteria. The position is 100% remote with core Pacific Standard Time hours, Monday–Friday, 8:00 AM–5:00 PM PST.

Competenze

• Active, unrestricted Washington State Pharmacist license (RPh) in good standing and valid U.S. pharmacist license.
• Minimum 2 years licensed pharmacist experience or completion of an ASHP-accredited PGY1 residency.
• Ability to rapidly interpret clinical criteria and navigate EMR review platforms.
• Self-motivated, metrics-driven, and able to deliver timely turnaround times.

Mansioni

• Conduct first-level UM and PA clinical reviews for pharmacy benefit medications.
• Apply clinical criteria and formulary guidelines to render approvals or denials.
• Process high-volume cases with accuracy and productivity targets (80–100/day).
• Collaborate with clinical and operational teams to maintain turnaround-time standards.

Conoscenze

Licensure

Clinical criteria interpretation

Remote work focus

UM/PA reviews

Formazione

ASHP residency

PharmD preferred

Strumenti

EMR systems

Office productivity suites

Descrizione del lavoro

About the Role

We are seeking a licensed Clinical Pharmacist (RPh) for a contract-to-hire opportunity supporting virtual pharmacy benefit operations. In this role, you will perform high-volume, first-level coverage determinations for prescription drug requests against established clinical guidelines and formulary criteria.

This is a focused, guideline-driven review role with no direct patient counseling and no peer-to-peer discussions, ideal for a pharmacist who thrives in an objective, fast-paced managed care environment.

Compensation & Work Arrangement

• Pay Rate: $70.00 - $80.00 per hour
• Role Type: Contract-to-Hire (1,040 hours / approximately 6 months)
• Schedule: Monday - Friday, 8:00 AM - 5:00 PM PST (40 hours/week, 1-hour unpaid lunch)
• Location & Modality: 100% Remote (Candidates can be based nationally, but must work core Pacific Standard Time business hours)
• Overtime: Not authorized
• Equipment: Bring Your Own Device (BYOD); dual-monitor setup strongly recommended

Key Responsibilities

• First-Level Coverage Determinations: Conduct comprehensive first-level utilization management (UM) and prior authorization (PA) clinical reviews for pharmacy benefit medications.
• Criteria Application: Evaluate clinical documentation, diagnostic reports, and medical histories to render timely approvals or denials adhering strictly to established clinical policies and formulary guidelines.
• High-Volume Case Processing: Maintain high analytical accuracy while achieving standard productivity metrics of approximately 80-100 completed cases per day once ramped.
• Formulary Support: Review drug literature and clinical data to support formulary integrity and cost-effective medication therapy.
• Cross-Functional Collaboration: Partner with clinical peers and operational teams to maintain turnaround-time compliance and regulatory standards.

Candidate Qualifications

Required:

• Licensure: Active, unrestricted Washington State Pharmacist license (RPh) in good standing, alongside an active U.S. pharmacist license.
• Experience: Minimum 2 years of licensed pharmacist experience OR completion of an ASHP-accredited PGY1 residency program.
• Technical Skills: Proven ability to rapidly interpret clinical criteria and navigate electronic medical/pharmacy review platforms and standard office productivity suites.
• Core Competencies: Ability to self-manage, maintain focus in a metrics-driven remote environment, and deliver consistent turnaround times.

Preferred

• Doctor of Pharmacy (PharmD) or relevant master's degree (MBA, MHA, MPH).
• Prior experience in Prior Authorization (PA), Utilization Management (UM), or Managed Care Pharmacy.
• Background in high-volume retail, mail-order, or health-system clinical pharmacy settings.
• Familiarity with NCQA and HEDIS quality accreditation standards.
• Experience with Medication Therapy Management (MTM) protocols.

* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

* As a job position within our Allied division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: providing direct patient care, accessing medical and confidential records, accessing and administering prescription medication or other drugs, working within a clinical setting, handling sharp instruments, conducting medical procedures, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.