Remote Clinical Pharmacy Reviewer: Prior Authorization & DUR

Remote Jobs; United States; Remote; USD 95,000 - 125,000; Full time

Benefits offered by this job

Remote work culture

Comprehensive benefits

Great Place to Work Certified

Job summary

Dane Street is seeking a Clinical Pharmacy Reviewer (Pharmacist) to evaluate complex prior authorization requests, appeals, and medication coverage determinations in a remote setting. The role applies evidence-based guidelines, formulary management, and Drug Utilization Review (DUR) to ensure medical necessity and regulatory compliance, impacting healthcare delivery.

Active pharmacist license in the U.S. and a PharmD are required, with at least three years in PBM prior authorization work,

Qualifications

• Minimum of 3 years of Prior Authorization and/or Appeals review experience within a PBM environment.
• Doctor of Pharmacy degree and active pharmacist license in the United States.
• Experience with Medicare Part D and Medicaid pharmacy benefits is preferred.

Responsibilities

• Evaluate complex prior authorization requests, appeals, and coverage determinations to ensure clinical appropriateness.
• Interpret drug criteria, formulary guidelines, step therapy, and quantity limits for meds.
• Perform Drug Utilization Review (DUR) to uphold medical necessity and regulatory compliance.
• Provide expertise to ensure accurate and compliant benefit determinations.

Skills

Prior Authorization & Appeals review

Drug Utilization Review (DUR)

Interpret complex clinical guidelines

Formulary management strategies

Education

Doctor of Pharmacy (PharmD)

Active pharmacist license in any U.S. State

Job description

Dane Street is seeking a Clinical Pharmacy Reviewer (Pharmacist) to evaluate complex prior authorization requests, appeals, and medication coverage determinations in a remote setting. The role applies evidence-based guidelines, formulary management, and Drug Utilization Review (DUR) to ensure medical necessity and regulatory compliance, impacting healthcare delivery.

Active pharmacist license in the U.S. and a PharmD are required, with at least three years in PBM prior authorization work,