Remote Prior Authorization Pharmacist – Specialty Pharmacy

Soleo Health; Texas; Remote; USD 110,000 - 150,000; 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 emphasizes timely, evidence-based prior authorizations, payer communications, and denial prevention to ensure patient access to therapy.

The position requires a PharmD or Bachelor of Pharmacy with an active U.S. license and 2+ years in prior authorization, utilization management, or payer pharmacy operations.

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.
• Strong understanding of drug therapy, clinical guidelines, specialty medications, and formulary management.
• Excellent analytical, clinical decision-making, and documentation skills.
• Proficiency in pharmacy benefit systems, prior authorization platforms, and electronic documentation.
• Strong written and verbal communication skills.
• Ability to manage multiple priorities and perform in a fast-paced environment with strict timelines.
• High level of integrity and ability to handle confidential or sensitive clinical information.

Responsibilities

• 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 Pharmacy Benefit Managers (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 and submit evidence-based appeal letters, including clinical rationale, literature support, and policy alignment, 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.
• Identify opportunities for workflow and training optimization and contribute to process improvement initiatives aimed at improving efficiency, compliance, and patient access.

Job description

Soleo Health is seeking a Prior Authorization Pharmacist to support our specialty infusion pharmacy and work remotely (USA). This role emphasizes timely, evidence-based prior authorizations, payer communications, and denial prevention to ensure patient access to therapy.

The position requires a PharmD or Bachelor of Pharmacy with an active U.S. license and 2+ years in prior authorization, utilization management, or payer pharmacy operations.