Prior Authorization Clinical Pharmacist (100% Remote – Licensed and based in Pennsylvania)
Job Number: NR7142384
Pay Rate: $113700-127700 / year
Job Description
Prior Authorization Clinical Pharmacist (100% Remote – Licensed and based in Pennsylvania)
Location: Remote (Must be located/licensed in PA)
Schedule: Monday – Friday, Day Shift (8:00 AM – 5:00 PM EST)
New Hire Starting Base Pay: $113,700 – $127,700 per year (Starting pay based on experience, with clear advancement pathways as you build specialized expertise.)
Future Earning Potential: Established employees have the opportunity to earn progressive pay increases up to $170,000 per year, over time through performance, tenure, and continuous learning.
Job Type: Full-Time, Direct-Hire (Permanent placement on company payroll with immediate full benefits; not a temporary job)
How You'll Make an Impact
- Clinical Prior Authorization Review: Perform expert clinical reviews for Prior Authorization, Step Therapy, Quantity Limits, and other pharmacy utilization management requests against standard clinical criteria and regulatory policies.
- Appeals & Exception Management: Participate in the pharmacy appeals process, review denied cases, and represent the organization at fair hearings and committee meetings.
- Stakeholder Call Queue Support: Manage clinical queue inquiries from internal and external stakeholders regarding exception processes, delivering timely and accurate drug information.
- Regulatory Compliance Oversight: Ensure all utilization management reviews comply with state and federal regulations, including CMS, NCQA, PID, and PA DHS standards.
- Virtual Collaboration & Mentorship: Maintain a compliant, confidential home office setting while working independently and mentoring pharmacy students, residents, and peers.
What We’re Looking For – Minimum Job Requirements
- Experience: Experience in pharmacy benefit management (PBM), health insurance, or managed care preferred (such as 1–3 years of managed care experience or completion of a Managed Care Residency).
- Education: Bachelor of Science in Pharmacy or Doctor of Pharmacy (Pharm.D.) degree from an accredited U.S. School of Pharmacy.
- Technical Skills: Strong computer literacy for pharmacy programming, word processing, EMR/claims data management, and drug information research.
- Industry Knowledge: Understanding of claims adjudication, therapeutic substitution, dose optimization, cost containment strategies, and CMS/NCQA regulatory standards.
- Soft Skills: Exceptional written and oral communication, sharp analytical skills, self-motivation for remote work, and strong organizational abilities.
- Licensure & Clearances: Active Pharmacist (RPh) license in the Commonwealth of Pennsylvania (or eligibility via reciprocity); Act 34 PA Criminal Record Check.
What We Offer
- Predictable Work-Life Balance: Monday through Friday daylight schedule with 100% remote work-from-home flexibility.
- Competitive Compensation & Growth: Starting pay based on experience, with clear advancement pathways into managed care leadership and specialized pharmacy administration.
- Comprehensive Benefits Package: Top-tier health, dental, and vision insurance starting day one.
- Generous Retirement Match: Retirement savings with up to an 8% employer match contribution.
- Education Investment: Up to $6,000/year in tuition assistance plus tuition discounts at 30+ partner schools.