Job Description:
Job Title: Pharmacist 1
Duration: 6 months (Possible Extension)
Location: Remote
Shift: 10am 6:30pm EST, OT possible (Mon-Fri)
About the Role:
Seeking Clinical Pharmacists to support its Medication Prior Authorization Review team. This position plays a critical role in evaluating clinical prior authorizations and coverage determinations for Medicaid, Medicare, and Health Exchange members. This is a remote role with a highly collaborative team focused on quality and efficiency in managed care pharmacy services.
Key Responsibilities:
Evaluate and process 140 160 clinical prior authorizations and coverage determinations per day.
Develop and implement medication clinical criteria, drug utilization review (DUR) programs, and quality initiatives.
Provide clinical consultation and support across internal departments.
Monitor and improve pharmacy quality standards and recommend plan design adjustments.
Participate in the Medicare Medication Therapy Management (MTM) program coordination.
Assist case management teams through member discussions and clinical presentations.
Required Qualifications:
Bachelor's or Doctor of Pharmacy (PharmD) degree.
Current, active pharmacist license with no restrictions in any U.S. state.
1 3 years of experience in mail order, retail, hospital, or managed care pharmacy, or 1 year of pharmacy residency.
Strong skills in clinical decision making, adaptability, and the ability to learn quickly.
Willingness to participate in a rotating weekend schedule.
Preferred Experience:
Experience with managed care, pharmacy benefit management (PBM), or coverage determinations.
Familiarity with Medicaid, Medicare, and ACA pharmacy regulations and criteria.
Prior involvement in DUR, MTM, or formulary development is a plus.
Team & Culture:
High-performing and collaborative pharmacy team.
Remote-based with structured training and ongoing support.
Clear performance expectations and focus on clinical accuracy.
Additional Notes:
Subcontracting is strictly prohibited.
Contractors must sign a Temporary Worker Acknowledgement.
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