Job Description:
Job Title: Clinical Pharmacist 1
Assignment Duration: 6 Months (Possible Extension & Conversion)
Location: Remote
Working Hours: Monday Friday, 9:00 AM 5:30 PM
Position Overview
The Clinical Pharmacist I support Pharmacy Services by reviewing and adjudicating prior authorization requests for medical benefit (buy-and-bill) medications across Medicare, Medicaid, Exchange, and Commercial lines of business. This fully remote role requires strong clinical judgment, in-depth drug knowledge, and experience in managed care or pharmacy benefit management environments.
Key Responsibilities
Review and adjudicate prior authorization requests for medical benefit (buy-and-bill) drugs using established clinical criteria
Apply evidence-based guidelines to approve or deny provider medication requests
Develop and maintain clinical criteria, policies, and procedures related to pharmacy operations
Support utilization management, drug utilization review (DUR), and quality improvement initiatives
Collaborate with internal clinical teams, case management, and pharmacy leadership
Provide clinical consultation and respond to medication-related inquiries from internal stakeholders
Participate in Medicare Medication Therapy Management (MTM) programs
Assist case management teams through clinical rounds and complex case reviews
Meet productivity and quality benchmarks ( 40 cases/day; 90% production, 95 99% quality targets)
Maintain accurate documentation and compliance with regulatory and organizational standards
Required Qualifications
Education
Bachelor's degree in Pharmacy or Doctor of Pharmacy (PharmD)
Licensure
Active, unrestricted Pharmacist license (State-ranked preference below)
Experience
1+ years of experience in retail, hospital, managed care, PBM, or mail-order pharmacy
Prior experience reviewing prior authorizations strongly preferred
Preferred Qualifications
Managed care or PBM prior authorization review experience
Medical benefit (buy-and-bill) drug review experience
Strong clinical decision-making skills
Experience with Outlook, Microsoft Teams, SharePoint, and Excel
Ability to work independently in a high-volume, metrics-driven environment
Preferred State Licenses (Ranked)
North Carolina
California
New Jersey
Arizona
Kansas
Texas
Indiana
Georgia
Why This Role
Fully remote opportunity
High-impact role supporting multiple lines of business
Temp-to-perm conversion potential
Strong alignment with culture of accountability, curiosity, trust, and service
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