Remote Prior Authorization Pharmacist — Managed Care Specialist

Pharmacy Careers; Redmond (WA); Remote; USD 110,000 - 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 therapies. This remote role supports a managed care environment and emphasizes evidence-based determinations.

The position requires a PharmD or Bachelor of Pharmacy with a U.S. license, strong clinical review, and clear communication skills to collaborate with providers and patients.

Qualifications

• PharmD or bachelor-level pharmacy degree required.
• Active and unrestricted pharmacist license in the U.S.
• Experience in prior authorization, utilization management, or managed care preferred.
• Excellent clinical review, documentation, and communication skills.

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

CMS rules

Utilization management

Education

PharmD

Pharmacy degree

Job description

Pharmacy Careers is seeking a Remote Prior Authorization Pharmacist to evaluate prescription requests, ensure medical necessity, and improve patient access to therapies. This remote role supports a managed care environment and emphasizes evidence-based determinations.

The position requires a PharmD or Bachelor of Pharmacy with a U.S. license, strong clinical review, and clear communication skills to collaborate with providers and patients.