Senior Clinical Pharmacy Reviewer - PBM, Remote

Dane Street; Washington (District of Columbia); Remote; USD 110,000 - 140,000; Full time

Benefits offered by this job

Collaborative remote culture

Professional growth opportunities

Comprehensive benefits

Great Place to Work Certified

Job summary

Dane Street is seeking a Clinical Pharmacy Reviewer (Pharmacist) to evaluate complex prior authorization requests, appeals, and coverage determinations, ensuring clinical appropriateness and evidence-based compliance. The role leverages extensive DUR knowledge and formulary management to support high-quality healthcare delivery.

We foster a collaborative, remote culture with professional growth opportunities and comprehensive benefits.

Qualifications

• PharmD degree from an accredited university.
• Active, unencumbered pharmacist license in any U.S. State.
• Minimum 3 years of Prior Authorization and/or Appeals review experience in a PBM environment.
• Experience with Medicare Part D and Medicaid benefits is preferred.

Responsibilities

• Evaluate complex prior authorization requests, appeals, and coverage determinations for clinical appropriateness.
• Interpret complex drug criteria, formulary guidelines, step therapy, and quantity limits.
• Perform Drug Utilization Review (DUR) to ensure medical necessity and compliance.
• Contribute as a subject matter expert in pharmacy benefit management and regulatory excellence.

Skills

Prior Authorization reviews

Appeals review

PBM expertise

Drug criterion interpretation

DUR knowledge

Education

Doctor of Pharmacy (PharmD)

Active pharmacist license (US)

Job description

Dane Street is seeking a Clinical Pharmacy Reviewer (Pharmacist) to evaluate complex prior authorization requests, appeals, and coverage determinations, ensuring clinical appropriateness and evidence-based compliance. The role leverages extensive DUR knowledge and formulary management to support high-quality healthcare delivery.

We foster a collaborative, remote culture with professional growth opportunities and comprehensive benefits.