Remote Prior Authorization Pharmacist: Improve Access

Pharmacy Careers; Woonsocket (RI); Remote; USD 120,000 - 150,000; Full time

Job summary

Pharmacy Careers is seeking a Remote Prior Authorization Pharmacist to evaluate prescription requests, ensure medical necessity, and improve patient access to safe therapies. This 100% work-from-home role is ideal for pharmacists transitioning from retail or hospital settings.

You will apply plan criteria, collaborate with providers, and document outcomes in line with CMS/state regulations while building expertise in utilization management and managed care.

Qualifications

• Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy is required.
• Active and unrestricted pharmacist license in the U.S.
• Experience in prior authorization, utilization management, or managed care preferred.

Responsibilities

• Review prior authorization requests for accuracy, appropriateness, and clinical necessity.
• Apply plan criteria, evidence-based guidelines, and regulatory standards to determinations.
• Communicate approval/denial decisions clearly 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

Clinical review

Documentation

Communication

Utilization management

Education

Doctor of Pharmacy or Bachelor of Pharmacy

Job description

Pharmacy Careers is seeking a Remote Prior Authorization Pharmacist to evaluate prescription requests, ensure medical necessity, and improve patient access to safe therapies. This 100% work-from-home role is ideal for pharmacists transitioning from retail or hospital settings.

You will apply plan criteria, collaborate with providers, and document outcomes in line with CMS/state regulations while building expertise in utilization management and managed care.