Remote Prior Authorization Pharmacist — Specialty Care

Soleo Health; United States; A distancia; USD 110.000 - 150.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Competitive Wages

401(k) with a Match

Referral Bonus

Paid Time Off

Great Company Culture

Annual Merit Based Increases

No Weekends or Holidays

Paid Parental Leave Options

Affordable Medical, Dental, & Vision

Company Paid Disability & Basic Life

HSA & FSA Options

Education Assistance Program

Descripción de la vacante

Soleo Health is seeking a Prior Authorization Pharmacist to support our Specialty Infusion Pharmacy and work Remotely (USA). This role performs comprehensive clinical reviews, assesses documentation, and communicates with PBMs to obtain timely approvals. Monday–Friday schedule, Mountain Standard Time preferred.

With 2+ years in prior authorization or payer pharmacy operations, you will help optimize patient access to specialty therapies while staying current with payer policies and guidelines.

Formación

• Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy from an accredited institution.
• Active, unrestricted U.S. pharmacist license.
• 2+ years of experience in prior authorization, utilization management, PBM, managed care, or payer pharmacy operations.
• Strong understanding of drug therapy, clinical guidelines, specialty medications, and formulary management.
• Excellent analytical, clinical decision-making, and documentation skills.

Responsabilidades

• Conduct comprehensive clinical reviews for specialty pharmacy and infusion therapy prior authorization requests to ensure appropriateness, accuracy, and completeness.
• Evaluate clinical documentation against payer-specific medical necessity criteria, coverage policies, and clinical guidelines.
• Prepare, submit, and track prior authorization requests to PBMs and health plans to ensure timely determinations.
• Communicate directly with PBMs and health plans to clarify clinical information, respond to requests for additional documentation, and resolve authorization issues.
• Proactively mitigate denials by addressing rejections in real time through live outreach to PBMs and payers; create evidence-based appeal letters as needed.
• Collaborate with patient access team and other internal stakeholders to obtain required documentation and optimize patient access to therapy.
• Monitor authorization outcomes and track performance metrics to identify delays, barriers, or trends impacting patient access.
• Stay current with evolving payer policies, clinical guidelines, and regulatory requirements affecting specialty pharmacy and infusion services.

Conocimientos

PBM knowledge

Clinical decision-making

Analytical skills

Documentation skills

Communication skills

Educación

Doctor of Pharmacy (PharmD)

Bachelor of Pharmacy

Herramientas

PA platforms

Pharmacy benefit systems

Electronic documentation systems

Descripción del empleo

Soleo Health is seeking a Prior Authorization Pharmacist to support our Specialty Infusion Pharmacy and work Remotely (USA). This role performs comprehensive clinical reviews, assesses documentation, and communicates with PBMs to obtain timely approvals. Monday–Friday schedule, Mountain Standard Time preferred.

With 2+ years in prior authorization or payer pharmacy operations, you will help optimize patient access to specialty therapies while staying current with payer policies and guidelines.