Remote Prior Authorization Pharmacist (PBM/Managed Care)

A-Line Staffing Solutions; Woonsocket (RI); Remote; USD 60,000 - 86,000; Full time

Job summary

A-Line Staffing Solutions is hiring a Remote Pharmacist to perform criteria-based prior authorization reviews and issue coverage determinations for specialty and non-specialty programs. The role suits pharmacists with PBM/managed care experience who can handle high volumes, communicate determinations, and document accurately across systems.

The position offers full-time hours with CST shifts and a training period. Remote work setup and secure home office are required.

Qualifications

• Active Pharmacist license in good standing.
• Prior authorization review experience (PBM/health plan preferred).
• Strong clinical judgment and meticulous documentation.
• Profi­cient phone presence and professional communication.

Responsibilities

• Review PA requests and render coverage determinations using clinical criteria and plan design.
• Verify insurance eligibility and interpret guideline criteria.
• Consult with providers and communicate approvals/denials promptly.
• Coordinate with PA team to gather required documentation.
• Handle calls with providers/members and resolve escalations.
• Maintain knowledge of drug and disease states for therapies.
• Document all activity clearly while meeting service levels.

Skills

Pharmacist license

Prior authorization

Clinical judgment

Communication skills

HIPAA compliance

Tools

VPN token

Job description

A-Line Staffing Solutions is hiring a Remote Pharmacist to perform criteria-based prior authorization reviews and issue coverage determinations for specialty and non-specialty programs. The role suits pharmacists with PBM/managed care experience who can handle high volumes, communicate determinations, and document accurately across systems.

The position offers full-time hours with CST shifts and a training period. Remote work setup and secure home office are required.