Remote Prior Authorization Pharmacist

A-Line Staffing Solutions; Woonsocket (RI); Remote; USD 60,000 - 86,000; Full time

Job summary

A-Line Staffing Solutions is hiring a Remote Pharmacist to perform criteria-based prior authorization reviews and issue coverage determinations for specialty and non-specialty programs. The role suits pharmacists with PBM/managed care experience who can handle high volumes, communicate determinations, and document accurately across systems.

The position offers full-time hours with CST shifts and a training period. Remote work setup and secure home office are required.

Qualifications

• Active Pharmacist license in good standing.
• Prior authorization review experience (PBM/health plan preferred).
• Strong clinical judgment and meticulous documentation.
• Profi­cient phone presence and professional communication.

Responsibilities

• Review PA requests and render coverage determinations using clinical criteria and plan design.
• Verify insurance eligibility and interpret guideline criteria.
• Consult with providers and communicate approvals/denials promptly.
• Coordinate with PA team to gather required documentation.
• Handle calls with providers/members and resolve escalations.
• Maintain knowledge of drug and disease states for therapies.
• Document all activity clearly while meeting service levels.

Skills

Pharmacist license

Prior authorization

Clinical judgment

Communication skills

HIPAA compliance

Tools

VPN token

Job description

Job Title

Remote Prior Authorization Pharmacist (Pharmacist – Prior Auth)

Location

Remote (continental U.S.; not available in New Mexico or Colorado)

Schedule

Full-time | Sun–Thurs or Tues–Sat (CST shifts)

Shift Options (CST)

10:30am–7:00pm | 11:00am–7:30pm | 11:30am–8:00pm

Training

Nov 9–Dec 4 | Mon–Fri 8:00am–4:30pm CST (mandatory)

Pay

$53.00/hour

Summary

Hiring a Remote Pharmacist to complete criteria-based prior authorization (PA) reviews and issue coverage determinations for specialty and non-specialty pharmacy programs. This is a great fit for pharmacists with PBM / managed care / health plan experience who are comfortable working high-volume cases, communicating determinations, and documenting accurately in multiple systems. If you’re searching for remote pharmacist jobs, prior authorization pharmacist, PBM pharmacist, or managed care pharmacist roles—this opportunity offers structured training and consistent schedules.

Responsibilities

• Review prior authorization requests and render coverage determinations using clinical criteria and plan design
• Verify insurance eligibility/coverage; interpret clinical guideline criteria
• Consult with providers as needed; communicate approvals/denials promptly and professionally
• Collaborate with technicians and PA team members to gather required clinical documentation
• Handle inbound/outbound calls with providers/members/PA team to resolve escalations and answer questions
• Maintain current knowledge of drug and disease states for specialty and non-specialty therapies
• Document all activity clearly and accurately while meeting service level expectations

Qualifications

• Active Pharmacist license (unrestricted; in good standing)
• Prior authorization review experience (PBM / managed care / health plan strongly preferred)
• Strong clinical judgment, documentation skills, and attention to detail
• Professional phone presence; comfortable with provider outreach and high-volume workflows
• Able to work in a secure home office and maintain confidentiality (HIPAA/privacy standards)
• Reliable high-speed internet (min 25 Mbps download / 3 Mbps upload) and a smartphone (VPN token required)
• Dedicated private workspace; hard requirement to complete training and assigned schedule