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Posted 24 days ago
Requirements and responsibilities
Job Title: Clinical Prior Authorization Pharmacist
Duration: 5 plus month with possible extension
Location: Fully Remote
Pay Range: $55- 60.00/hr
This is a Clinical Pharmacist Position supporting Medicaid Prior Authorization.
An active AZ or TX pharmacist license that is in good standing is required.
We are hiring for the 10:00 am - 6:30 pm shift AZ time (post training).
The training schedule is: 8:00 am - 4:30 pm AZT (approximately 8 weeks).
The Prior Authorization Pharmacist is responsible for reviewing and evaluating medication prior authorization requests to ensure appropriate, safe, and cost-effective therapy in accordance with clinical guidelines, regulatory requirements, and organizational policies. This role applies clinical judgement to support optimal patient outcomes while balancing utilization management outcomes.
Review, assess, and adjudicate medication prior authorization requests for medical necessity, clinical appropriateness, and formulary compliance.
Apply evidence-based clinical guidelines, drug compendia, FDA labeling, and plan-specific criteria to authorization decisions.
Support peer-to-peer reviews and prepare clinical summaries when escalation is required.
Ensure compliance with state and federal regulations, accreditation standards (e.g. NCQA, URAC), and internal audit requirements.
Maintain productivity, turnaround time, and quality benchmarks for prior authorization processing.
Experience working in a high production team environment.
3+ years experience working as a pharmacist.
Knowledge of clinical program components, formulary designs, and prescription benefit trends.
High School Diploma or GED required. Bachelor's degree in pharmacy or Pharm D. also required with at least two years experience as a pharmacist.
Must have an active license in good standing.
Mon-Fri 10 AM-6:30 PM AZ Time (Mon-Fri 8AM-4:30 PM AZ Time)
Optionally, you can add more information later (benefits, pre-screening questions, etc.)