Remote Clinical Pharmacist: Prior Authorization & Appeals

Pacer Group; Alaska; Remote; USD 62,000 - 90,000; Full time

Job summary

Pacer Group in the United States is seeking a Clinical Pharmacist 1 to support a Pharmacy Appeals team responsible for reviewing prior authorization requests, pharmacy appeals, coverage determinations, formulary requirements, and medication-related clinical criteria. The role emphasizes applying medical policy and professional judgment to ensure appropriate medication access.

The ideal candidate has at least 1 year of pharmacist experience, strong clinical judgment, excellent time-management,

Qualifications

• Doctor of Pharmacy (PharmD) required.
• Current pharmacist license in good standing in any U.S. state.
• At least 1 year of professional RPh experience required.
• Strong clinical judgment and decision-making skills.
• Excellent organization and time-management abilities.
• Self-motivated and goal-oriented.
• Ability to independently manage a high-volume workload.
• Working knowledge of Microsoft Office Suite.
• Strong written and verbal communication skills.

Responsibilities

• Review completed prior authorization requests and denials for clinical appropriateness.
• Review formulary alternatives, clinical comments, attachments, and documentation.
• Verify member information and eligibility in health plan systems.
• Verify coverage and benefits when required.
• Evaluate prescription claim history and lab values.
• Apply Medical Policy Criteria to PA requests.
• Draft non-formulary criteria when needed.
• Communicate with physicians about non-formulary meds and plan benefits.
• Provide guidance to technicians and support staff.

Skills

Pharmacist experience

Clinical judgment

Time management

Communication skills

Education

Doctor of Pharmacy (PharmD)

Tools

Microsoft Office

Job description

Pacer Group in the United States is seeking a Clinical Pharmacist 1 to support a Pharmacy Appeals team responsible for reviewing prior authorization requests, pharmacy appeals, coverage determinations, formulary requirements, and medication-related clinical criteria. The role emphasizes applying medical policy and professional judgment to ensure appropriate medication access.

The ideal candidate has at least 1 year of pharmacist experience, strong clinical judgment, excellent time-management,