Remote Clinical Pharmacy Specialist - Prior Authorization

Pittsburgh Tomorrow; Pittsburgh (Allegheny County); Remote; USD 105,000 - 135,000; Full time

Job summary

UPMC Health Plan is hiring a full-time Clinical Pharmacy Specialist to support the Prior Authorization Team. This work-from-home role operates 8:00 a.m.–5:00 p.m. EST and requires PA licensure and current RPh registration.

The specialist will perform clinical reviews for prior authorizations and appeals, ensure compliance with NCQA and CMS standards, and collaborate with internal teams to optimize member care.

Qualifications

• Licensed pharmacist in PA or eligible for licensure by examination or reciprocity.
• BSPharm or Pharm.D. from an accredited U.S. school.
• Experience in pharmacy benefit management or managed care preferred.
• Strong communication, analytical, and organizational skills.
• Computer literacy for pharmacy programming and data management.

Responsibilities

• Perform clinical review of Prior Authorization, Step Therapy, Quantity Limit requests per clinical criteria and policies.
• Critically review utilization management requests for approval/denial.
• Participate in clinical call queue for inquiries related to exception process.
• Contribute to the pharmacy appeals process and committee representation at hearings.

Skills

Analytical ability

Communication skills

Organizational skills

Computer literacy

Education

Bachelor of Science in Pharmacy (BSPharm)

Doctor of Pharmacy (Pharm.D.)

Job description

UPMC Health Plan is hiring a full-time Clinical Pharmacy Specialist to support the Prior Authorization Team. This work-from-home role operates 8:00 a.m.–5:00 p.m. EST and requires PA licensure and current RPh registration.

The specialist will perform clinical reviews for prior authorizations and appeals, ensure compliance with NCQA and CMS standards, and collaborate with internal teams to optimize member care.