Prior Authorization Pharmacist

A-Line Staffing is now hiring a Full-Time, Remote, Prior Authorization Pharmacist!

Position Summary

The Pharmacist/Clinician is an operations-based role responsible for conducting criteria-based clinical reviews of medical information collected during the prior authorization process.

The Pharmacist will apply clinical knowledge and plan-approved criteria when reviewing cases and rendering coverage determinations.

This position is supporting systems and includes inbound and outbound communication with physicians, healthcare providers, members, technicians, and other Prior Authorization team members regarding pending, approved, and denied prior authorization requests.

The Pharmacist will also provide internal clinical support to the Prior Authorization and Member Services teams and may provide on-call or after-hours pharmacist availability for urgent prior authorization requests as needed.

Prior Authorization Pharmacist Compensation

• The pay for this position is $53/hr THERE IS NO ROOM TO GO UP OR DOWN, THE SET RATE IS $53/HR
• Benefits are available to full-time employees after 90 days of employment
• A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates

Prior Authorization Pharmacist Highlights

• This position is a contract assignment with potential to hire on permanently based upon attendance, performance, and business needs
• The required availability for this position
• • Sunday–Thursday OR Tuesday–Saturday
  • 10:30 AM–7:00 PM CST
  • 11:00 AM–7:30 PM CST
  • 11:30 AM–8:00 PM CST
  • November 9–December 4, 2026
    Monday–Friday | 8:00 AM–4:30 PM CST FOR TRAINING

Prior Authorization Pharmacist Responsibilities

Prior Authorization Clinical Review – 60%

• Evaluate and review prior authorization requests.
• Render coverage determinations based on clinical criteria and plan design.
• Verify insurance coverage and eligibility.
• Interpret clinical guidelines and coverage criteria.
• Review relevant clinical and medical information.
• Consult with physicians and other healthcare providers when necessary.
• Appropriately utilize clinical knowledge and available resources.
• Comply with established department protocols and procedures.
• Ensure case decisions are communicated promptly and accurately to healthcare providers, health plans/employers, patients, and other appropriate parties.
• Follow established approval and denial management procedures.

Provider & Team Collaboration – 25%

• Collaborate with technicians and Prior Authorization team members to process referrals.
• Answer clinical questions and collect appropriate medical and clinical information.
• Complete clinical assessments and reviews according to health plan/employer criteria and established service-level agreements.
• Handle inbound and outbound calls with physicians, healthcare providers, technicians, PA team members, and/or patients.
• Assist with inquiries and escalations related to prior authorization requests.

Clinical Knowledge – 10%

Maintain professional and technical knowledge of medications and disease states associated with Specialty and Non-Specialty Pharmacy programs administered within the Commercial Specialty line of business.

Additional Responsibilities – 5%

• Attend required training and development meetings.
• Complete additional projects and duties as assigned.
• Provide on-call or after-hours pharmacist availability for urgent PA requests when required.

Prior Authorization Pharmacist Requirements

·         Active Pharmacist License required

·         Bachelor's Degree in Pharmacy required; PharmD preferred

·         2 years of Prior Authorization review experience strongly preferred

·         PBM, Managed Care, or Health Plan experience strongly preferred

·         Specialty Pharmacy experience is a plus

·         Previous PBM pharmacy experience preferred

·         Approximately 1–3 years of related experience required; 3–5 years preferred

·         Comfortable handling high-volume inbound and outbound provider interactions

·         Comfortable with approximately 50 calls per day

·         Able to manage approximately 40 prior authorization cases per day

·         Previous remote work experience

·         Strong verbal and written communication skills

·         Strong documentation skills

·         Strong organizational and interpersonal skills

·         Excellent attention to detail

·         Basic computer proficiency

·         Available for the entire mandatory training period

·         Comfortable working one weekend day each week

·         Verifiable High School Diploma or GED required

If you think this Prior Authorization Pharmacist position is a good fit for you, please reach out to me—feel free to call, e-mail, or apply to this posting