Remote Clinical Pharmacist 1: Prior Authorization Specialist

Pacer Group; Town of Texas (WI); Remote; USD 83,000 - 90,000; Full time

Job summary

Pacer Group seeks a Clinical Pharmacist 1 for a remote, 3-month assignment focused on prior authorization review, formulary alternatives, and clinical decision support. You will verify member details, eligibility, and coverage while applying policy criteria with professional judgment.

Pharm D. licensure in the United States and at least one year of pharmacist experience are required. Experience with managed care and Medicare/Medicaid law is a plus.

Qualifications

• Pharm D. degree required.
• Active US pharmacist license required (state unspecified).
• Minimum 1 year of professional RPh experience.

Responsibilities

• Review prior authorization requests and evaluate formulary alternatives and criteria.
• Verify member ID, date of birth, and eligibility in health plan systems.
• Record carrier and group numbers and review prior authorization decisions.
• Assess prescription history, chart notes, and lab values to determine approval.
• Apply Medical Policy Criteria and professional judgment for non-formulary requests.
• Research and provide drug references to physicians or staff to support PA reviews.
• Communicate with physicians about non-formulary drugs, benefits, exclusions, and formulary alternatives.

Skills

RPh experience

Pharmacist experience

Managed care

Medicare/Medicaid knowledge

Education

Pharm D.

Job description

Pacer Group seeks a Clinical Pharmacist 1 for a remote, 3-month assignment focused on prior authorization review, formulary alternatives, and clinical decision support. You will verify member details, eligibility, and coverage while applying policy criteria with professional judgment.

Pharm D. licensure in the United States and at least one year of pharmacist experience are required. Experience with managed care and Medicare/Medicaid law is a plus.