Pharmacist (100% Remote)

ACTalent; Houston (TX); Remote; USD 63,000 - 89,000; Full time

Benefits offered by this job

Medical, dental & vision

401(k) Retirement Plan

Life Insurance

Short and long-term disability

Health Spending Account (HSA)

Transportation benefits

PTO / Vacation / Sick Leave

Job summary

ACTalent is seeking a Pharmacist to remotely review Utilization Management requests for Medicaid members, applying criteria and clinical judgment to approve or deny prior authorization requests. You will communicate with prescribers and providers via fax and electronic submissions, with no direct patient interaction, in a fully remote role with potential cross-training opportunities.

This contract position offers benefits and long-term growth, with shifts including evenings and rotating

Qualifications

• Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy degree.
• Current pharmacist license in good standing with the applicable State Board of Pharmacy where the candidate is licensed.
• Minimum of 2 years of experience as a licensed pharmacist in retail, managed care, or clinical pharmacy.
• Experience with pharmacy benefits management or prior authorization processes (preferred)

Responsibilities

• Review Utilization Management requests for Medicaid members, including formulary exceptions, prior authorization, step therapy, and quantity limit exception requests.
• Apply client-specific criteria, clinical guidelines, and professional judgment to determine whether prior authorization requests should be approved or denied.
• Document all clinical decisions clearly and accurately in the appropriate systems, ensuring compliance with internal policies and regulatory requirements.
• Communicate with prescribers and providers by phone, fax, and electronic systems to clarify information, obtain additional clinical details, and explain determinations, handling approximately 510 calls per day.
• Use pharmacy benefits management tools and systems to process requests efficiently while maintaining high quality and attention to detail.
• Manage a steady workflow of electronic and fax submissions, prioritizing cases based on urgency, complexity, and established turnaround times.
• Independently make clinical decisions within defined criteria and elevate complex or ambiguous cases as appropriate.
• Maintain productivity, accuracy, and quality metrics as defined by leadership, including production volume, work quality, and attendance standards.
• Adapt to evolving policies, procedures, and criteria, incorporating updates into daily decision‑making and documentation.
• Participate in required training sessions and apply new knowledge to review specialized cases when opportunities arise (such as oncology, hepatitis C, and other complex conditions).
• Collaborate with internal teams and leadership to support consistent application of criteria and best practices across the Utilization Management function.
• Provide professional, courteous, and timely communication to providers and internal stakeholders to support efficient case resolution.
• Maintain confidentiality of member information and adhere to all applicable privacy and security regulations.
• Potentially cross‑train and support other departments, such as Medication Therapy Management or Call Center Counseling, if opportunities are available and performance criteria are met.
• Work assigned shifts, including evenings and rotating weekends, and comply with scheduling requirements, blackout periods, and holiday coverage expectations.

Skills

Pharmacist license

PBM experience

Clinical review

Education

PharmD or BS Pharmacy

Job description

Pharmacist (PA Review)

100% Remote | Offers Benefits | Long-term Growth

Job Description

This remote Pharmacist role focuses on reviewing Utilization Management requests for Medicaid members, including formulary exceptions, prior authorization, step therapy, and quantity limit exception requests. You will apply client-specific criteria and clinical judgment to determine whether to approve or deny prior authorization requests while maintaining high accuracy and attention to detail. The position involves frequent communication with prescribers and providers, primarily via fax and electronic submissions, with a moderate volume of phone calls and no direct patient interaction. This opportunity is ideal for pharmacists seeking to transition away from retail settings into a pharmacy benefits management and managed care environment, with potential for future cross-training and long-term employment.

Responsibilities

• Review Utilization Management requests for Medicaid members, including formulary exceptions, prior authorization, step therapy, and quantity limit exception requests.
• Apply client-specific criteria, clinical guidelines, and professional judgment to determine whether prior authorization requests should be approved or denied.
• Document all clinical decisions clearly and accurately in the appropriate systems, ensuring compliance with internal policies and regulatory requirements.
• Communicate with prescribers and providers by phone, fax, and electronic systems to clarify information, obtain additional clinical details, and explain determinations, handling approximately 510 calls per day.
• Use pharmacy benefits management tools and systems to process requests efficiently while maintaining high quality and attention to detail.
• Manage a steady workflow of electronic and fax submissions, prioritizing cases based on urgency, complexity, and established turnaround times.
• Independently make clinical decisions within defined criteria and elevate complex or ambiguous cases as appropriate.
• Maintain productivity, accuracy, and quality metrics as defined by leadership, including production volume, work quality, and attendance standards.
• Adapt to evolving policies, procedures, and criteria, incorporating updates into daily decision‑making and documentation.
• Participate in required training sessions and apply new knowledge to review specialized cases when opportunities arise (such as oncology, hepatitis C, and other complex conditions).
• Collaborate with internal teams and leadership to support consistent application of criteria and best practices across the Utilization Management function.
• Provide professional, courteous, and timely communication to providers and internal stakeholders to support efficient case resolution.
• Maintain confidentiality of member information and adhere to all applicable privacy and security regulations.
• Potentially cross‑train and support other departments, such as Medication Therapy Management or Call Center Counseling, if opportunities are available and performance criteria are met.
• Work assigned shifts, including evenings and rotating weekends, and comply with scheduling requirements, blackout periods, and holiday coverage expectations.

Essential Skills

• Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy degree.
• Current pharmacist license in good standing with the applicable State Board of Pharmacy where the candidate is licensed.
• Minimum of 2 years of experience as a licensed pharmacist in retail, managed care, or clinical pharmacy.
• Experience with pharmacy benefits management or prior authorization processes (preferred)

Job Type & Location

This is a Contract position based out of Houston, TX.

Pay and Benefits

The pay range for this position is $55.00 - $55.00/hr.

Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

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)

Application Deadline

This position is anticipated to close on Nov 27, 2026.

Workplace Type

This is a fully remote position.

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 20,000 consultants and 5,000 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. We are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a ClearlyRated Best of Staffing® winner for both client and talent service.

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 process due to a disability, please email [e-mail] for other accommodation options.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.