Remote Clinical Pharmacist: Prior Authorization Expert

HireTalent - Staffing & Recruiting Firm; United States; Remote; USD 120,000 - 150,000; Full time

Benefits offered by this job

Remote work from home

40 hours per week (CST)

Career growth opportunities

Job summary

HireTalent - Staffing & Recruiting Firm in the United States is hiring a 100% remote Clinical Pharmacist to review patient medication requests and support access to life-changing therapies. You will work within a managed care environment, applying evidence-based criteria to determine coverage decisions and collaborating with prescribers.

This full-time role (40 hours/week, CST hours) offers remote work from home, opportunities for professional growth, and exposure to a broad payer landscape.

Qualifications

• PharmD degree required and eligible to practice.
• 3+ years of pharmacist experience, preferably in managed care.
• Experience with prior authorization, utilization management, or clinical review.
• Experience in health plans, PBMs, or insurance environments.
• Strong knowledge of clinical criteria for medication coverage.

Responsibilities

• Review and evaluate prior authorization requests for medications.
• Apply guidelines and criteria to determine coverage decisions.
• Assess appeals and reconsiderations.
• Engage in peer-to-peer discussions with prescribers when needed.
• Support quality assurance and clinical audits.
• Provide guidance on pharmacy-related questions.
• Promote safe, appropriate, cost-effective medication use.
• Ensure compliance with regulations and industry standards.

Skills

Prior Authorization

Utilization Management

Clinical Review

Managed Care

Healthcare Communications

Education

Doctor of Pharmacy (PharmD)

Job description

Job Title:100% REMOTE Clinical Pharmacist

🚀Join a growing healthcare organization where your clinical expertise directly impacts patient access to life-changing medications.

We are seeking experienced Clinical Pharmacists to join a dynamic team responsible for reviewing medication authorization requests and ensuring evidence-based, patient-focused coverage decisions. This is an excellent opportunity for pharmacists who enjoy applying clinical knowledge, collaborating with healthcare providers, and working in a managed care environment.

What You'll Do

✅Review and evaluate prior authorization requests for specialty and non-specialty medications

✅Apply clinical guidelines and medical necessity criteria to make coverage determinations

✅Assess appeals and reconsideration requests

✅Conduct peer-to-peer discussions with prescribing physicians when needed

✅Support quality assurance initiatives and clinical audits

✅Provide expertise and guidance to internal teams on pharmacy-related questions

✅Help ensure safe, appropriate, and cost-effective medication use

✅Maintain compliance with all applicable regulations and industry standards

What We're Looking For

Required Qualifications

• Doctor of Pharmacy (PharmD)
• 3+ years of pharmacist experience
• Prior authorization, utilization management, or clinical review experience
• Experience working within a health plan, managed care, PBM, or insurance environment
• Strong understanding of clinical criteria and medication coverage decisions
• Excellent communication skills and confidence speaking with physicians and healthcare providers

Preferred Qualifications

• Board Certification (BCPS, BCOP, or similar)
• Pharmacy residency training
• Experience developing or applying clinical review criteria
• Background in retail, hospital, specialty, or managed care pharmacy
• 100% Remote (CST hours)
• Full-time, 40 hours per week
• Monday-Friday
• 8:00 AM - 5:00 PM CST

Eligible Locations

Candidates must reside in one of the approved U.S. states. Remote work is not available in California, Florida, Alaska, Delaware, Hawaii, Louisiana, Montana, North Dakota, Oklahoma, West Virginia, or Wyoming

Why This Opportunity?

⭐ Gain valuable prior authorization and managed care experience

⭐ Work remotely from home

⭐ Be part of a collaborative pharmacy operations team

⭐ Opportunity for contract extension and career growth

Interested? Apply today with your updated resume and active unrestricted state pharmacist license details. These openings are expected to move quickly. 🚀