Remote Prior Authorization Pharmacist — Clinical Coverage

Moda Health; Portland (OR); Remote; USD 104,000 - 132,000; Full time

Benefits offered by this job

Medical, Dental, Vision & Pharmacy

PTO and Holidays

401k - Matching

Job summary

Moda Health is seeking a skilled pharmacist to join its clinical pharmacy team in a temporary, remote role focusing on prior authorization functions. You will make coverage determinations and process appeal requests using established criteria and plan designs, impacting patient care.

The position offers a pay range reflected publicly and may be hourly depending on location. Oregon licensure within 60 days is required, with opportunities to support multiple lines of business from a remote setting.

Qualifications

• Active, unrestricted Oregon Pharmacist license or eligible within 60 days.
• Strong communication with healthcare providers and internal teams.
• Commitment to service and professional conduct.
• Works well under pressure with interruptions and shifting priorities.
• Adheres to HR policies, Code of Conduct, and confidentiality.

Responsibilities

• Evaluate medication requests for coverage and perform clinical reviews against guidelines and formularies.
• Provide prior authorization pharmacist coverage for rotating weekends and holidays.
• Offer on-call support for urgent medication requests and assist pharmacy, appeals, and customer services teams.
• Perform coverage determinations for all lines of business for both pharmacy and medical medications.
• Participate in appeals and grievances with clinical expertise and review of complaints.
• Conduct medical literature evaluations to support decisions.
• Perform peer-to-peer reviews with providers when requested.
• Recommend improvements to coverage criteria and medication edits based on utilization.
• Provide timely, clear drug information responses to members, clients, and staff with documentation.
• Organize workload and prioritize tasks to meet departmental standards.
• Support quality assurance and ongoing improvement initiatives.
• Stay updated on communications and processes and apply to daily duties.
• Assist staff training and development as required.
• Review and maintain applicable clinical pharmacy policies and procedures.
• Perform other related duties as assigned.

Skills

Oregon license

Communication skills

Interpersonal skills

Pressure management

Policy adherence

Education

Pharm.D.

Job description

Moda Health is seeking a skilled pharmacist to join its clinical pharmacy team in a temporary, remote role focusing on prior authorization functions. You will make coverage determinations and process appeal requests using established criteria and plan designs, impacting patient care.

The position offers a pay range reflected publicly and may be hourly depending on location. Oregon licensure within 60 days is required, with opportunities to support multiple lines of business from a remote setting.