Remote Pharmacist (Prior Authorization / PBM)

A-Line Staffing Solutions; Woonsocket (RI); Remote; USD 69,000 - 77,000; Full time

Job summary

A-Line Staffing Solutions is seeking a remote Pharmacist to perform prior authorization reviews and determine coverage using plan criteria. You will collaborate with the team to gather clinical data, communicate decisions to providers, and ensure PHI/privacy standards are maintained.

Requires an active Pharmacist license and prior authorization experience; high-speed internet, a private workspace, and smartphone access are mandatory for a 100% remote role across the continental U.S.

Qualifications

• Active Pharmacist license in the state of residence/practice (must be in good standing).
• Prior authorization experience strongly preferred (PBM/managed care a plus).
• MTM, DUR, or clinical review/documentation experience helpful.
• Strong provider communication and decision documentation skills.
• Stable work history and professionalism (clean, well-written resume matters).
• WFH requirements (must have)
• High-speed internet (min 25 Mbps down / 3 Mbps up) + speed test screenshot.
• Smartphone required (token/VPN access).
• Private, secure workspace (no interruptions).

Responsibilities

• Review prior authorization requests and render coverage determinations using clinical criteria and plan design.
• Collaborate with technicians/prior auth team to gather clinical information and resolve escalations.
• Handle inbound/outbound calls with providers and teams; communicate approvals/denials clearly.
• Document determinations accurately and maintain strict PHI/privacy compliance.
• Manage daily case volume and follow established SLAs and workflows.

Skills

Prior authorization experience

Strong provider communication

Clinical review/documentation

Tools

VPN access

PHI/privacy compliance

Job description

Remote Pharmacist (Work From Home) – Prior Authorization / Coverage Determination

We’re hiring experienced Remote Pharmacists to complete clinical prior authorization reviews and make coverage determinations using plan criteria.

Pay: $53/hr

Location: 100% Remote (continental U.S.; not available in NM or CO)

Schedule Options (CST): Sun–Thurs OR Tues–Sat | 10:30a–7:00p, 11:00a–7:30p, or 11:30a–8:00p

Training: Nov 9 – Dec 4 | Mon–Fri 8:00a–4:30p CST (mandatory)

What you’ll do

• Review prior authorization requests and render coverage determinations using clinical criteria and plan design.
• Collaborate with technicians/prior auth team to gather clinical information and resolve escalations.
• Handle inbound/outbound calls with providers and teams; communicate approvals/denials clearly.
• Document determinations accurately and maintain strict PHI/privacy compliance.
• Manage daily case volume and follow established SLAs and workflows.

What we’re looking for

• Active Pharmacist license in the state of residence/practice (must be in good standing).
• Prior authorization experience strongly preferred (PBM/managed care a plus).
• MTM, DUR, or clinical review/documentation experience helpful.
• Strong provider communication and decision documentation skills.
• Stable work history and professionalism (clean, well-written resume matters).
• WFH requirements (must have)
• High-speed internet (min 25 Mbps down / 3 Mbps up) + speed test screenshot.
• Smartphone required (token/VPN access).
• Private, secure workspace (no interruptions).