Job Description
Role / Responsibilities
Review and make determinations on prior authorization requests for medications under the pharmacy benefit
Conduct peer-to-peer calls with prescribers regarding adverse determinations
Participate in clinical quality audits and inter-rater reliability testing
Support internal teams with pharmacy escalations and clinical questions
Apply clinical expertise to ensure appropriate and safe medication use
Maintain compliance with all applicable laws and regulations
Required Qualifications
Doctor of Pharmacy (PharmD)
Active, unrestricted pharmacist license
3+ years of experience working as a licensed pharmacist
Willingness to obtain additional state licenses and/or training as needed
Preferred Background
1+ year of managed care clinical review experience and/or experience writing clinical criteria
Prior authorization, utilization management, PBM, or clinical review experience
Strong experience applying clinical criteria
Board certification such as BCPS or BCOP
Residency training
Pay
$60/hour
Start Date
10/26/2026
Contract Duration
Through April 2026
Limited PTO is requested from January through March due to busy season
Any planned PTO during the contract must be provided with the candidate’s resume
Schedule
Candidates will eventually need to work at least one weekend shift per week, either Saturday or Sunday
Potential schedules include four 10-hour shifts or five 8-hour shifts
Training will be M-F, 8:30 AM–5:00 PM CST
Weekend shifts are expected to begin approximately two months after the start date
Training
3–4 weeks of group training
Combination of self-study and instructor-led training
No PTO requested during the training period
Recruiting / Interview Process
Candidate completes a case study within 48 business hours of receiving it
Candidates who pass the case study move into interviews
Two interviews:
30 minutes with a Senior Clinical Pharmacist
30 minutes with a Pharmacist Supervisor
Location / Remote Requirements
This appears to be a fully remote position, but candidates must reside and perform their work in one of the approved states unless otherwise approved by the Insurance Group.
Approved locations include
AL, AZ, AR, CO, CT, DC, FL, GA, ID, IL, IN, IA, KS, KY, ME, MD, MA, MI, MN, MS, MO, NE, NV, NH, NJ, NM, NY, NC, OH, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA and WI.