Remote Prior Authorization Pharmacist — Impact & Growth

Pharmacy Careers; Summerville (SC); Remote; USD 90,000 - 130,000; Full time

Job summary

Pharmacy Careers in the United States is seeking a Remote Prior Authorization Pharmacist to evaluate prescription requests, ensure medical necessity, and improve patient access to therapies within a managed care framework. This 100% remote role suits pharmacists seeking to move from retail or hospital settings while expanding expertise in utilization management.

Key duties include reviewing prior authorization requests, applying plan criteria, and communicating decisions to providers.

Qualifications

• Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy degree required.
• Active and unrestricted pharmacist license in the U.S.
• Experience in prior authorization, utilization management, or managed care preferred; retail or hospital pharmacists encouraged to apply.
• Strong clinical judgment and communication skills.

Responsibilities

• Review prior authorization requests for accuracy and clinical necessity.
• Apply plan criteria, guidelines, and regulatory standards to determinations.
• Communicate approval/denial decisions to providers and patients.
• Collaborate with physicians, nurses, and medical directors on complex cases.
• Document outcomes in compliance with health plan policies and CMS/state regulations.
• Support process improvements to streamline workflow and turnaround times.

Skills

PharmD/BPharm

US licensure

Prior authorization

Clinical documentation

Communication skills

Education

PharmD or BPharm

Job description

Pharmacy Careers in the United States is seeking a Remote Prior Authorization Pharmacist to evaluate prescription requests, ensure medical necessity, and improve patient access to therapies within a managed care framework. This 100% remote role suits pharmacists seeking to move from retail or hospital settings while expanding expertise in utilization management.

Key duties include reviewing prior authorization requests, applying plan criteria, and communicating decisions to providers.