Remote Pharmacist I: PBM Utilization & PA

Actalent; Eagan (MN); Remote; USD 63,000 - 89,000; Full time

Benefits offered by this job

Generous vacation allotment

Comprehensive benefits package

401(k) retirement plan

Medical, dental & vision

Job summary

Actalent is seeking a Pharmacist I for a fully remote position based in the United States, with the role focusing on reviewing Medicaid Utilization Management requests and prior authorizations. The pharmacist will collaborate with prescribers via fax and electronic submissions, handling a high daily call volume and maintaining compliance with policies.

Qualifications include PharmD or BS in Pharmacy and a current active license, plus at least 2 years’ experience in retail, managed care, or

Qualifications

• Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy degree.
• Current pharmacist license in good standing with the applicable State Board of Pharmacy.
• Minimum of 2 years of experience as a licensed pharmacist in retail, managed care, or clinical pharmacy.
• Experience with pharmacy benefits management or prior authorization processes.
• Ability to make independent clinical decisions within defined criteria and professional standards.
• Strong ability to prioritize tasks and manage multiple cases or projects simultaneously.
• Results-driven mindset with a demonstrated drive to deliver outcomes and meet performance metrics.
• Self-motivated and able to work independently without constant direction or feedback.
• Flexibility and resourcefulness in adapting to changing policies, processes, and workload demands.
• Proficiency in learning and using new computer systems and working with multiple monitors.
• Basic IT troubleshooting skills for common work-from-home technology issues.
• Proficiency with Microsoft Word and Excel.
• Ability to type at least 35 words per minute.
• Clear, professional verbal and written communication skills for interacting with providers and documenting decisions.
• High level of attention to detail and accuracy in clinical review and documentation.

Responsibilities

• Review Utilization Management requests for Medicaid members, including formulary exceptions, prior authorization, step therapy, and quantity limit exception requests.
• Apply client-specific criteria, clinical guidelines, and professional judgment to determine whether prior authorization requests should be approved or denied.
• Document all clinical decisions clearly and accurately in the appropriate systems, ensuring compliance with internal policies and regulatory requirements.
• Communicate with prescribers and providers by phone, fax, and electronic systems to clarify information, obtain additional clinical details, and explain determinations, handling approximately 510 calls per day.
• Use PBM tools and systems to process requests efficiently while maintaining quality.
• Manage a steady workflow of electronic and fax submissions, prioritizing cases based on urgency and turnaround times.
• Independently make clinical decisions within defined criteria and elevate complex cases as needed.
• Maintain productivity, accuracy, and quality metrics as defined by leadership.
• Adapt to evolving policies, procedures, and criteria, incorporating updates into daily decisions and documentation.
• Participate in required training sessions and apply new knowledge to review specialized cases when opportunities arise.
• Collaborate with internal teams and leadership to support consistent application of criteria and best practices.
• Provide professional, courteous, and timely communication to providers and internal stakeholders.
• Maintain confidentiality of member information and adhere to privacy regulations.
• Cross-train and support other departments if opportunities arise and performance criteria are met.
• Work assigned shifts, including evenings and rotating weekends, and comply with scheduling requirements.

Skills

Pharmacist license

PBM experience

Independent clinical decision making

Multitasking

Remote work readiness

Provider communication

Attention to detail

Tech proficiency (Word/Excel, monitors

Typing 35 wpm

Telephonic call handling

Education

PharmD or BS in Pharmacy

Licensed Pharmacist in good standing

Tools

PBM systems

Electronic submissions platforms

Microsoft Word

Microsoft Excel

Multiple monitors setup

Job description

Actalent is seeking a Pharmacist I for a fully remote position based in the United States, with the role focusing on reviewing Medicaid Utilization Management requests and prior authorizations. The pharmacist will collaborate with prescribers via fax and electronic submissions, handling a high daily call volume and maintaining compliance with policies.

Qualifications include PharmD or BS in Pharmacy and a current active license, plus at least 2 years’ experience in retail, managed care, or