Remote PA Pharmacist | Clinical Decisions & Access

Medix; Maryland; Remote; USD 90,000 - 130,000; Full time

Job summary

Medix is seeking a remote clinical Pharmacist to evaluate prior authorization requests for formulary and non-formulary medications. You will apply evidence-based guidelines and regulatory standards to render timely clinical determinations and partner with providers, pharmacies, and health plan teams.

In this role, you will review medical records, document the clinical rationale, and communicate determinations clearly.

Qualifications

• Active, unrestricted Pharmacist license in your state of residence.
• Hands-on experience conducting clinical reviews and rendering PA decisions.
• Background in utilization management, managed care, PBM, or health plan pharmacy operations.
• Experience with PBM systems, PA platforms, and remote documentation software.
• Excellent verbal and written communication with providers and plan staff.

Responsibilities

• Clinical Review & Determination: Evaluate PA requests for formulary and non-formulary meds; render timely approval, denial, or modification decisions based on guidelines and standards.
• Documentation & Communication: Maintain precise records of clinical rationale and case details; clearly communicate determinations and coverage policies to prescribers and pharmacies.
• Operational & Team Support: Serve as a clinical resource for escalated inquiries; advise on benefit interpretation, step-therapy substitutions, formulary exceptions, and workflow troubleshooting.

Skills

Pharmacist license

Clinical PA reviews

PBM experience

Communication

Remote collaboration

Education

PharmD (Doctor of Pharmacy)

Tools

PBM systems

PA platforms

EHR software

Job description

Medix is seeking a remote clinical Pharmacist to evaluate prior authorization requests for formulary and non-formulary medications. You will apply evidence-based guidelines and regulatory standards to render timely clinical determinations and partner with providers, pharmacies, and health plan teams.

In this role, you will review medical records, document the clinical rationale, and communicate determinations clearly.