Remote Prior Authorization Pharmacist (Specialty Pharmacy)

Soleo Health Inc; Frisco (TX); Remote; USD 110,000 - 140,000; Full time

Benefits offered by this job

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

Job summary

Soleo Health is seeking a Prior Authorization Pharmacist to support our Specialty Infusion Pharmacy and work Remotely (USA). This role focuses on clinical reviews, payer criteria, and efficient PA submissions to PBMs and health plans.

You will evaluate documentation, prepare evidence-based appeals, and collaborate with internal teams to improve patient access to therapy while maintaining compliance and high-quality documentation in a fast-paced environment.

Qualifications

• 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.

Responsibilities

• Conduct comprehensive clinical reviews for prior authorization requests for specialty pharmacy and infusion therapies.
• Evaluate clinical documentation against payer medical necessity criteria and coverage policies.
• Prepare, submit, and track PA requests to PBMs and health plans to ensure timely determinations.
• Communicate with PBMs/health plans to clarify clinical information and resolve authorization issues.
• Mitigate denials with real-time outreach and submit evidence-based appeal letters as needed.
• Collaborate with patient access and internal teams to obtain required documentation for therapy access.
• Monitor authorization outcomes and track performance metrics to identify delays or barriers.

Skills

Prior Authorization

Pharmacist

PBM experience

Utilization management

Education

PharmD or Bachelor of Pharmacy

Tools

PA platforms

PBM systems

Job description

Soleo Health is seeking a Prior Authorization Pharmacist to support our Specialty Infusion Pharmacy and work Remotely (USA). This role focuses on clinical reviews, payer criteria, and efficient PA submissions to PBMs and health plans.

You will evaluate documentation, prepare evidence-based appeals, and collaborate with internal teams to improve patient access to therapy while maintaining compliance and high-quality documentation in a fast-paced environment.