Job Description

Job Description

Job Description

Job Title: Remote PBM Prior Authorization Pharmacist

Pay: $53 an hr | Bi-weekly

Job Type: Remote

Start date: 09/07/25

Shift Options:

• Schedule: Mon-Fri 9:30am - 6:00pm local time; Training will be Mon-Fri 8:00am - 4:30pm CT

• Previous pharmacy experience ***in PBM and Prior Authorization*** required.

Remote PBM Prior Authorization Pharmacist Overview:

• The clinical pharmacist is an operation based role that conducts clinical reviews of medical data collected to perform prior authorization for specialty medications.
• The clinical pharmacist will apply clinical knowledge to plan approved criteria for prospective and concurrent reviews of cases.
• This role will work from supported systems and take inbound calls from physician or members regarding their pending, approved, or denied prior authorizations.
• Collaborates with the Technicians and Nurses to process authorization requests, including answering clinical questions, collecting appropriate clinical/ medical data needed to perform clinical assessments, and reviews as per the health plan/employer agreed criteria within the designated service level agreements. (20%)
• Coordinates timely communication of case decision to physician, health-plan/employer, patient and other healthcare professionals following agreed upon approval & denial management processes. (15%)
• Handles inbound phone calls and escalations from physicians or patients regarding Prior Authorization (50%)
• Establishes and maintains communication among health plan and employer group staff. (5%)
• Maintain professional and technical knowledge of drug and disease-states for the Specialty Medical programs administered within the Novologix. (5%)
• Performs other related projects and duties as assigned including on call and after hours pharmacist availability could be required. (5%)

Remote PBM Prior Authorization Pharmacist Qualifications:

• Previous pharmacy experience ***in PBM and Prior Authorization*** required.
• Minimum of 2-5 years of clinical experience with specialty medications or clinical review of prior authorization requests is preferred.
• Experience using MS Office and other Windows based computer applications, strong organizational skills, interpersonal skills, and detail orientation are important for this position.
• Required certification:
  Active pharmacist license in state of residence in good standing
• Education:
  Bachelor's degree in pharmacy or Pharm D. required with at least two years experience as a pharmacist.
• Must have an active license in good standing.

Remote PBM Prior Authorization Pharmacist Benefits:

• Benefits are available to full-time employees after 90 days of employment and include health, optical, dental, life, and short-term disability insurance.
• A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates.

How to Apply:

If you are interested in this position, please apply OR submit your resume to:

Saw Hlaing | [email protected] | 412-790-5425

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