Remote Clinical Pharmacist: Utilization & PA Decisions

Medical Solutions; Springfield (OH); On-site; USD 151,536,000 - 172,200,000; Full time

Benefits offered by this job

Medical, dental & vision

401(k) Retirement Plan

Pre-tax and Roth post-tax

Life Insurance

Short and long-term disability

Health Spending Account (HSA)

Transportation benefits

Employee Assistance Program

Time Off/Leave

Job summary

Actalent is seeking a Clinical Pharmacist for a fully remote contract role. You will review utilization management requests and apply client-specific criteria to approve or deny prior authorizations, while collaborating with healthcare providers and internal teams.

The position requires a PharmD or BS in Pharmacy, current licensure, and experience in retail, managed care, or clinical pharmacy. This remote role offers comprehensive benefits and is positioned to support client-specific decision

Qualifications

• PharmD or BS in Pharmacy required.
• Current pharmacist license in good standing with the State Board of Pharmacy.
• Experience in retail, managed care, or clinical pharmacy.

Responsibilities

• Review Medicare utilization management requests, including formulary exceptions, prior authorization, step therapy, and quantity limit exceptions.
• Use client criteria to determine approval or denial of prior authorizations.
• Conduct clinical evaluations for coverage determination requests, considering denial language and decision appropriateness.
• Consult directly with healthcare providers or members on non-formulary and clinical product coverage issues.
• Collaborate with team members to ensure consistency in decision-making across the pharmacist team.
• Participate in routine structured touchpoints and communicate regularly with supervisors and team members via Teams, phone, and video calls.

Skills

Clinical Pharmacist

Pharmacist License

Utilization management

Education

Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy degree

Job description

Actalent is seeking a Clinical Pharmacist for a fully remote contract role. You will review utilization management requests and apply client-specific criteria to approve or deny prior authorizations, while collaborating with healthcare providers and internal teams.

The position requires a PharmD or BS in Pharmacy, current licensure, and experience in retail, managed care, or clinical pharmacy. This remote role offers comprehensive benefits and is positioned to support client-specific decision