Remote Prior Authorization Pharmacist — Medicare Part D

A-Line Staffing Solutions; Woonsocket (RI); On-site; USD 62,000 - 83,000; Full time

Job summary

A-Line Staffing Solutions is seeking a licensed Pharmacist to remotely review and process prior authorization requests, ensuring medical necessity and regulatory compliance. You will evaluate clinical data, apply coverage policies, and determine determinations for diverse cases.

The role supports Medicare Part D processes, communicates outcomes to providers and patients, and handles high-volume workflow while collaborating with physicians and healthcare teams.

Qualifications

• Active Pharmacist license required.
• 2+ years of prior authorization review experience.
• PBM/managed care or health plan experience preferred.
• Remote work experience preferred.

Responsibilities

• Review prior authorization requests for accuracy, appropriateness, and medical necessity.
• Gather and evaluate clinical information, coverage policies, and authorization criteria.
• Make coverage determinations per regulatory and plan guidelines.
• Process Medicare Part D approvals and denials.
• Communicate approvals, denials, and incomplete requests to providers and patients.

Skills

Clinical judgment

Communication

Documentation

Education

Active Pharmacist license

Job description

A-Line Staffing Solutions is seeking a licensed Pharmacist to remotely review and process prior authorization requests, ensuring medical necessity and regulatory compliance. You will evaluate clinical data, apply coverage policies, and determine determinations for diverse cases.

The role supports Medicare Part D processes, communicates outcomes to providers and patients, and handles high-volume workflow while collaborating with physicians and healthcare teams.