Remote PBM Pharmacist – Prior Authorization Specialist

A-Line Staffing Solutions; Miami (FL); Remote; USD 62,000 - 83,000; Full time

Job summary

A-Line Staffing Solutions seeks an experienced Pharmacist to perform criteria-based clinical reviews and issue prior authorization determinations for PBM programs in a fully remote role across the continental U.S. This contract-to-hire position supports high-volume provider interaction and requires meticulous documentation.

The role requires an active Pharmacist license and 2+ years of PA review experience, with PBM/managed care exposure highly preferred.

Qualifications

• Active Pharmacist license (required).
• 2+ years of PA review experience (required).
• PBM / Managed Care / Health Plan experience (strongly preferred).
• Specialty pharmacy exposure (plus).
• Strong communication and documentation skills; able to perform in a high-production environment.

Responsibilities

• Review prior authorization requests for accuracy, appropriateness and medical necessity.
• Interpret clinical criteria and plan guidelines; gather/assess clinical documentation.
• Communicate approvals/denials/incomplete requests to providers and patients.
• Handle high-volume inbound/outbound calls (approx. 50 calls/day).
• Manage a daily workload (approx. 40 PA cases/day); document determinations thoroughly.
• Support technicians and PA team to meet service level requirements.

Skills

PA review experience

PBM experience

High-volume calls

Documentation skills

Strong communication

Education

Bachelor's in Pharmacy

PharmD preferred

Job description

A-Line Staffing Solutions seeks an experienced Pharmacist to perform criteria-based clinical reviews and issue prior authorization determinations for PBM programs in a fully remote role across the continental U.S. This contract-to-hire position supports high-volume provider interaction and requires meticulous documentation.

The role requires an active Pharmacist license and 2+ years of PA review experience, with PBM/managed care exposure highly preferred.