Pharmacist

Actalent; Austin (TX); Remote; USD 10,000 - 60,000; Full time

Job summary

A leading company is seeking a dedicated Clinical Pharmacist as a Prior Authorization Specialist. This fully remote role involves reviewing prior authorization requests, ensuring compliance with medical policies, and utilizing clinical judgment to evaluate claims. Ideal candidates will have a PharmD and experience in managed care.

Benefits

Medical, dental & vision

401(k) Retirement Plan

Life Insurance

Short and long-term disability

Health Spending Account (HSA)

Transportation benefits

Employee Assistance Program

Time Off/Leave (PTO, Vacation or Sick Leave)

Qualifications

• At least one year of professional RPh experience.
• Experience in prior authorization processes.

Responsibilities

• Review prior authorization requests for compliance.
• Evaluate prescription claims and provide guidance.
• Develop criteria for non-formulary medication requests.

Skills

Managed Care

Attention to Detail

Clinical Judgment

Education

Doctor of Pharmacy (PharmD)

Bachelor of Science Pharmacy

Job description

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Job Title: Clinical Pharmacist - Prior Authorization Specialist

Job Description

We are seeking a dedicated Clinical Pharmacist to join our team as a Prior Authorization Specialist. This role involves reviewing and processing prior authorization requests to ensure compliance with medical policy criteria and health plan benefits. The ideal candidate will utilize clinical judgment and professional expertise to evaluate prescription claims and provide necessary guidance and documentation to healthcare providers.

Responsibilities

• Review completed prior authorization requests from providers and pharmacy technicians for appropriateness.
• Verify member's ID number, date of birth, and eligibility in the health plan system.
• Record carrier and group number when applicable.
• Check for previous prior authorization decisions and verify coverage in prescription and health plan benefits.
• Evaluate prescription claim history, review chart notes, and lab values.
• Identify provider specialty when relevant.
• Apply medical policy criteria to prior authorization requests and evaluate for approval.
• Use professional clinical judgment on a case-by-case basis to review medication requests.
• Develop and draft criteria for non-formulary medication requests not addressed by guidelines.
• Research and contribute drug references and clinical information to facilitate prior authorization review.
  
  

Essential Skills

• Doctor of Pharmacy (PharmD) or Bachelor of Science Pharmacy degree
• Current pharmacist license in good standing with the State Board of Pharmacy
• At least one year of professional RPh experience
• Experience working in managed care
• Understanding of Medicare/Medicaid law
  
  

Additional Skills & Qualifications

• Experience in prior authorization processes
• Proficiency in data entry and healthcare management
• Knowledge of Medication Therapy Management (MTM)
  
  

Work Environment

This position involves working fully remote in collaboration with physicians, pharmacy technicians, and other healthcare professionals. The role requires attention to detail and the ability to work independently, using technology and clinical resources to manage prior authorization processes efficiently.

Pay and Benefits

The pay range for this position is $60.00 - $65.00/hr.

Eligibility requirements apply to some benefits and may depend on your job

classification and length of employment. Benefits are subject to change and may be

subject to specific elections, plan, or program terms. If eligible, the benefits

Available For This Temporary Role May Include The Following

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)
  
  

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on May 23, 2025.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email [e-mail] for other accommodation options.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Contract

Job function

• Job function

  Health Care Provider

• Industries

  Business Consulting and Services

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