Remote Prior Authorization Pharmacist (PBM Experience Required)

Prior Authorization Pharmacist (PBM Experience Required) Location: Remote Schedule: Monday – Friday, Day Shift Job Overview We are seeking a Prior Authorization Pharmacist with direct experience in a PBM (Pharmacy Benefit Management) environment. This role is responsible for reviewing medication requests, evaluating clinical documentation, and making coverage determinations based on established guidelines and payer requirements. Candidates must have prior authorization and PBM experience to be considered.

Key Responsibilities

• Review and evaluate prior authorization requests using clinical criteria and coverage guidelines
• Determine approval, denial, or need for additional information based on formulary requirements
• Interpret and apply Medicare Part D and commercial plan benefits
• Review clinical documentation, patient profiles, and provider-submitted information
• Manage denials and appeals, ensuring appropriate follow-up and documentation
• Communicate with providers, patients, and internal teams regarding authorization decisions
• Ensure timely case processing while maintaining accuracy and compliance standards
• Maintain detailed documentation in accordance with regulatory and audit requirements
• Stay current on formulary updates, step therapy protocols, and utilization management guidelines

Qualifications

• Active Pharmacist license in good standing
• Prior Authorization experience REQUIRED
• PBM (Pharmacy Benefit Management) experience REQUIRED
• Experience with Medicare Part D, commercial plans, and formulary review strongly preferred
• Knowledge of drug utilization review (DUR) and clinical guidelines
• Experience in a high-volume or remote review environment preferred
• Strong analytical, documentation, and decision-making skills

Preferred Experience

• Experience with coverage determinations and appeals
• Familiarity with step therapy and formulary management
• Previous experience with major PBMs (OptumRx, CVS Caremark, Express Scripts, etc.)

Work Environment

• Remote or office-based depending on assignment
• High-volume, production-driven environment
• Computer-based clinical review and documentation

Why Join

• Stable weekday schedule
• Opportunity to work in a clinical, non-retail setting
• Structured workflows with clear guidelines
• Collaborative and compliance-driven environment

Apply Today If you have direct prior authorization and PBM experience and are looking to transition into or continue in a clinical review setting, we encourage you to apply. . Remote Skills: Analysis Skills, Clinical Practices/Protocols, Clinical Study Publications, Compensation and Benefits, Documentation, Formulary, Maintain Compliance, Medicare, Medications, Patient Care Authorizations, Pharmacy, Production Systems, Production Volume, Regulations, Regulatory Compliance, Retail, Scripting (Scripting Languages), Team Player, Time Management, Utilization Management About the Company: A-Line Staffing Solutions A-Line Staffing Solutions is a premier staffing company that supplies professionals to the Healthcare, Insurance, Pharmaceutical, and Information Technology industries. Founded in 2004, A-Line Staffing Solutions has been a leader in matching talented individuals to the jobs that our clients NEED to fill. We are experts at offering creative staffing solutions to employers, and we are hiring every day. A-Line Staffing can offer short-term, long-term and direct-hire opportunities to professionals across the United States. We hire only the most qualified and talented individuals in the country. Our recruiting, selection and stringent screening processes have strengthened our reputation for delivering quality customer service and unbeatable talent. For our commissioned clients, A-Line Staffing closely follows the standards and practices established by The Joint Commission. For all of our clients and employees, our commitment to continual improvement combined with a strict code of ethics provides an atmosphere of respect and unparalleled professionalism. To find out how A-Line Staffing Solutions can share our talent with you, please contact us today. We are eager to include you among our most valued and satisfied clients. If you are a professional and would like to learn more about open opportunities in your area, please contact us today. We are always searching for talented and enthusiastic professionals Company Size: 1,000 to 1,499 employees Industry: Staffing/Employment Agencies Founded: 2004 Website: http://www.alinestaffing.com/