Remote Prior Authorization Pharmacist — Clinical Reviews

Medix™; États-Unis; À distance; USD 90 000 - 120 000; Plein temps

Résumé du poste

Medix is seeking a remote Clinical Pharmacist to evaluate prior authorization requests for formulary and non-formulary medications. You will use evidence-based guidelines and regulatory standards to render timely clinical determinations while collaborating with providers, pharmacies, and health plan teams.

This full-time role requires an active Pharmacist license, PA review experience in PBM or health plan settings, and strong communication skills to document rationale and explain decisions.

Qualifications

• Active Pharmacist license in your state of residence.
• Hands-on experience conducting clinical reviews and PA determinations in a PBM/health plan environment.
• Experience with PBM systems, PA platforms, and remote documentation software.
• Strong verbal and written communication with providers, pharmacies, and health plan teams.

Responsabilités

• Evaluate prior authorization requests for formulary and non-formulary medications; render timely approval, denial, or modification decisions based on guidelines and standards.
• Maintain clear, accurate records of clinical rationale and case details in internal systems; communicate determinations and alternatives to prescribers and pharmacies.
• Serve as a resource for escalated inquiries, guiding benefit interpretation, step-therapy substitutions, formulary exceptions, and workflow issues.

Connaissances

Pharmacist license

PA review experience

PBM systems experience

Remote communication skills

Formation

PharmD or state Pharmacist license

Outils

PBM platforms

EHR/documentation software

Remote collaboration tools

Description du poste

Medix is seeking a remote Clinical Pharmacist to evaluate prior authorization requests for formulary and non-formulary medications. You will use evidence-based guidelines and regulatory standards to render timely clinical determinations while collaborating with providers, pharmacies, and health plan teams.

This full-time role requires an active Pharmacist license, PA review experience in PBM or health plan settings, and strong communication skills to document rationale and explain decisions.