Prior Authorization Pharmacist

MedOp Solutions; United States; Remote; USD 70,000 - 95,000; Full time

Job summary

MedOp Solutions is seeking a remote Pharmacist to perform complex prior authorization reviews and clinical determinations. You will collaborate with prescribers, conduct peer-to-peer calls, and contribute to quality audits while ensuring safe medication use.

The role requires a PharmD with 3+ years as a licensed pharmacist, willingness to obtain additional state licenses, and strong knowledge of PBM processes. This is a remote position available in approved states.

Qualifications

• PharmD required.
• 3+ years licensed pharmacist experience.
• Willingness to obtain additional state licenses or training.

Responsibilities

• Review and determine prior authorization requests for medications under the pharmacy benefit.
• Conduct peer-to-peer calls with prescribers regarding adverse determinations.
• Participate in clinical quality audits and inter-rater reliability testing.
• Support internal teams with pharmacy escalations and clinical questions.
• Apply clinical expertise to ensure appropriate and safe medication use.
• Maintain compliance with all applicable laws and regulations.

Skills

Clinical decision making

Peer-to-peer communication

Regulatory compliance

License readiness

Education

Doctor of Pharmacy (PharmD)

Tools

PBM systems

Job description

• Review and make determinations on prior authorization requests for medications under the pharmacy benefit
• Conduct peer-to-peer calls with prescribers regarding adverse determinations
• Participate in clinical quality audits and inter-rater reliability testing
• Support internal teams with pharmacy escalations and clinical questions
• Apply clinical expertise to ensure appropriate and safe medication use
• Maintain compliance with all applicable laws and regulations

Required Qualifications

• Doctor of Pharmacy (PharmD)
• 3+ years of experience working as a licensed pharmacist
• Willingness to obtain additional state licenses and/or training as needed

Preferred Background

• 1+ year of managed care clinical review experience and/or experience writing clinical criteria
• Prior authorization, utilization management, PBM, or clinical review experience
• Strong experience applying clinical criteria
• Board certification such as BCPS or BCOP
• Residency training

Pay

• $60/hour

Start Date

• 10/26/2026

Contract Duration

• Through April 2026
• Limited PTO is requested from January through March due to busy season
• Any planned PTO during the contract must be provided with the candidate’s resume

Schedule

• Candidates will eventually need to work at least one weekend shift per week, either Saturday or Sunday
• Potential schedules include four 10-hour shifts or five 8-hour shifts
• Training will be M-F, 8:30 AM–5:00 PM CST
• Weekend shifts are expected to begin approximately two months after the start date

Training

• 3–4 weeks of group training
• Combination of self-study and instructor-led training
• No PTO requested during the training period
• Candidate completes a case study within 48 business hours of receiving it
• Candidates who pass the case study move into interviews
• 30 minutes with a Senior Clinical Pharmacist
• 30 minutes with a Pharmacist Supervisor

Location / Remote Requirements

This appears to be a fully remote position, but candidates must reside and perform their work in one of the approved states unless otherwise approved by the Insurance Group.

Approved locations include:

AL, AZ, AR, CO, CT, DC, FL, GA, ID, IL, IN, IA, KS, KY, ME, MD, MA, MI, MN, MS, MO, NE, NV, NH, NJ, NM, NY, NC, OH, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA and WI.