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. .