Remote Clinical Pharmacist – Prior Authorization Specialist

Spectraforce Technologies; Houston (TX); On-site; USD 110,000 - 140,000; Full time

Job summary

Spectraforce Technologies is seeking a Clinical Pharmacist 1 for a remote, 3-month assignment. The role focuses on evaluating redetermination and appeals coverage requests, with duties spanning prior authorizations, data retrieval, and collaboration with physicians to ensure compliant formulary decisions.

The successful candidate will hold a Pharm D., have at least one year of RPh experience, and hold an active US state license.

Qualifications

• Pharm D. required.
• At least one year of professional RPh experience.
• Experience in managed care and Medicare/Medicaid knowledge preferred.
• Active pharmacy licensure in any US state.

Responsibilities

• Reviews and evaluates completed prior authorization requests for appropriateness.
• Verifies member ID, date of birth, and eligibility in health plans.
• Communicates with physicians about plan benefits, exclusions and formulary alternatives.
• Applies Medical Policy Criteria to determine approval of requests.
• Compiles data for reporting and supports National P&T Committee.
• Researches drug references and clinical information to aid reviews.

Skills

RPh experience

Clinical judgment

Communication skills

Education

Pharm D.

Tools

Office Suite

Job description

Spectraforce Technologies is seeking a Clinical Pharmacist 1 for a remote, 3-month assignment. The role focuses on evaluating redetermination and appeals coverage requests, with duties spanning prior authorizations, data retrieval, and collaboration with physicians to ensure compliant formulary decisions.

The successful candidate will hold a Pharm D., have at least one year of RPh experience, and hold an active US state license.