Temporary Remote Pharmacist: Prior Authorization & Appeals

Insperity; Oregon; Hybrid; USD 104,000 - 132,000; Full time

Benefits offered by this job

Medical, Dental, Vision & Pharmacy

PTO and Company Paid Holidays

401k - Matching

Job summary

Moda Health in Oregon seeks a skilled pharmacist to join our clinical pharmacy team. The role focuses on prior authorization activities, making coverage determinations based on established criteria and plan design to support high‑quality patient care.

This is a temporary role with work-from-home options. You will evaluate medication requests, support appeals, and collaborate with providers, internal teams, and the appeals unit to ensure appropriate access and consistent decision making.

Qualifications

• Current active and unrestricted Oregon Registered Pharmacist license, or eligible for Oregon licensure within 60 days of hire
• Effective communication and interpersonal skills to interact with healthcare providers, internal teams, and external stakeholders
• Commitment to service, organizational values, and professionalism through appropriate conduct and demeanor
• Works well under pressure with frequent interruptions and shifting priorities
• Follow HR policies, Code of Conduct, and all department policies and procedures including protecting confidential company, employee, and customer information

Responsibilities

• Evaluate medication requests for coverage and conduct clinical reviews per guidelines
• Provide prior authorization coverage for rotating weekends and holidays
• Support pharmacy team, appeals unit, and customer services with urgent requests
• Perform coverage determinations for all lines of business for pharmacy and medical medications
• Participate in appeals and grievances with clinical expertise
• Complete medical literature evaluation to support decisions
• Conduct peer-to-peer reviews with providers when requested
• Recommend coverage criterion improvements based on utilization
• Provide clear drug information responses via documentation
• Organize workload and prioritize duties per department standards
• Support quality assurance and ongoing improvement
• Stay current on communications and apply updates to daily duties
• Support staff training and development as required
• Review and maintain applicable clinical services policies
• Perform other related duties as assigned

Skills

Oregon Pharmacist license

Effective communication

Interpersonal skills

Work under pressure

Policy compliance

Education

Pharm.D.

Job description

Moda Health in Oregon seeks a skilled pharmacist to join our clinical pharmacy team. The role focuses on prior authorization activities, making coverage determinations based on established criteria and plan design to support high‑quality patient care.

This is a temporary role with work-from-home options. You will evaluate medication requests, support appeals, and collaborate with providers, internal teams, and the appeals unit to ensure appropriate access and consistent decision making.