Prior Authorization Pharmacist - 259803

Medix™; United States; Remote; USD 90,000 - 120,000; Full time

Job summary

Medix is seeking a remote Clinical Pharmacist to evaluate prior authorization requests for formulary and non-formulary medications. You will use evidence-based guidelines and regulatory standards to render timely clinical determinations while collaborating with providers, pharmacies, and health plan teams.

This full-time role requires an active Pharmacist license, PA review experience in PBM or health plan settings, and strong communication skills to document rationale and explain decisions.

Qualifications

• Active Pharmacist license in your state of residence.
• Hands-on experience conducting clinical reviews and PA determinations in a PBM/health plan environment.
• Experience with PBM systems, PA platforms, and remote documentation software.
• Strong verbal and written communication with providers, pharmacies, and health plan teams.

Responsibilities

• Evaluate prior authorization requests for formulary and non-formulary medications; render timely approval, denial, or modification decisions based on guidelines and standards.
• Maintain clear, accurate records of clinical rationale and case details in internal systems; communicate determinations and alternatives to prescribers and pharmacies.
• Serve as a resource for escalated inquiries, guiding benefit interpretation, step-therapy substitutions, formulary exceptions, and workflow issues.

Skills

Pharmacist license

PA review experience

PBM systems experience

Remote communication skills

Education

PharmD or state Pharmacist license

Tools

PBM platforms

EHR/documentation software

Remote collaboration tools

Job description

In this remote clinical role, you will evaluate prior authorization requests for formulary and non-formulary medications. You will leverage evidence-based guidelines and regulatory standards to render timely clinical determinations while serving as a trusted partner to healthcare providers, pharmacies, and health plan teams.

Shift: Monday - Friday (8:00am - 5:00pm PST)

Requirements:

• Licensure: Active, unrestricted Pharmacist (PharmD or RPh) license in your state of residence.
• Direct Experience: Must have hands‑on experience as a Licensed Pharmacist conducting clinical reviews and rendering decisions on prior authorizations (PAs) within a Pharmacy Benefit Manager (PBM), PBM‑adjacent platform, or health plan environment.
• Technical Proficiency: Demonstrated experience working within pharmacy benefit management (PBM) systems, prior authorization platforms, and electronic health/documentation software in a remote setup.
• Communication: Outstanding verbal and written communication skills for engaging with providers, health plan representatives, and clinical peers telephonically and digitally.

Key Responsibilities

• Clinical Review & Determination: Evaluate prior authorization requests for formulary and non-formulary medications; render timely approval, denial, or modification decisions based on evidence‑based guidelines, clinical criteria, and regulatory standards.
• Documentation & Communication: Maintain precise records of clinical rationale and case details in internal systems while clearly communicating determinations, coverage policies, and alternative therapeutic options to prescribers and pharmacies.
• Operational & Team Support: Serve as a subject‑matter clinical resource for escalated inquiries, offering guidance on benefit interpretation, step‑therapy substitutions, formulary exceptions, and workflow troubleshooting.