Remote Pharmacist (Prior Authorization / PBM)

Remote Pharmacist (Work From Home) – Prior Authorization / Coverage Determination Pay: $53/hr Location: 100% Remote (continental U.S.; not available in NM or CO) Schedule Options (CST): Sun–Thurs OR Tues–Sat | 10:30a–7:00p, 11:00a–7:30p, or 11:30a–8:00p Training: Nov 9 – Dec 4 | Mon–Fri 8:00a–4:30p CST (mandatory) We’re hiring experienced Remote Pharmacists to complete clinical prior authorization reviews and make coverage determinations using plan criteria. This is a high-volume, productivity-driven PBM / managed care pharmacist environment—ideal for pharmacists with prior auth, coverage determination, MTM/DUR, or strong high-volume retail experience with payer issues. What you’ll do Review prior authorization requests and render coverage determinations using clinical criteria and plan design Collaborate with technicians/prior auth team to gather clinical information and resolve escalations Handle inbound/outbound calls with providers and teams; communicate approvals/denials clearly Document determinations accurately and maintain strict PHI/privacy compliance Manage daily case volume and follow established SLAs and workflows What we’re looking for Active Pharmacist license in the state of residence/practice (must be in good standing) Prior authorization experience strongly preferred (PBM/managed care a plus) MTM, DUR, or clinical review/documentation experience helpful Strong provider communication and decision documentation skills Stable work history and professionalism (clean, well-written resume matters) WFH requirements (must have) High-speed internet (min 25 Mbps down / 3 Mbps up) + speed test screenshot Smartphone required (token/VPN access) Private, secure workspace (no interruptions)