Prior Authorization Pharmacist

Job Title: Clinical Pharmacist – Prior Authorization (Remote)

Job Description

This role focuses on reviewing and adjudicating prescription medication prior authorization requests using clinical criteria, regulatory standards, and evidence-based guidelines. You will evaluate the medical necessity, safety, and appropriateness of requested therapies, communicate clear decisions and recommendations to healthcare professionals, and contribute to continuous improvement of clinical and operational processes in a fully remote work setting.

Responsibilities

• Review and adjudicate prior authorization requests for prescription medications in accordance with plan policies, clinical criteria, FDA labeling, and evidence-based guidelines.
• Evaluate the medical necessity, safety, and appropriateness of requested therapies for a wide range of clinical conditions.
• Apply utilization management criteria, including step therapy protocols, quantity limits, and formulary alternatives, to ensure appropriate and cost-effective use of medications.
• Communicate authorization decisions clearly, professionally, and in a timely manner to prescribers, pharmacists, and internal stakeholders.
• Provide clinical recommendations and suggest alternative therapy options when requests do not meet approval criteria, supporting optimal patient care.
• Document all clinical decisions accurately, thoroughly, and consistently within authorization systems and related platforms.
• Ensure compliance with state and federal regulations, including CMS, NCQA, and URAC standards, throughout the prior authorization process.
• Participate in denial reviews, appeals, and peer-to-peer consultations as needed to support fair and evidence-based outcomes.
• Support the development, review, and maintenance of clinical criteria and formulary policies to keep them aligned with current evidence and regulations.
• Collaborate with medical directors, nurses, pharmacy technicians, and operations teams to improve authorization workflows and turnaround times.
• Monitor trends in prior authorization requests, identify opportunities for process improvement, and support quality initiatives aimed at enhancing efficiency and clinical outcomes.

Essential Skills

• Active and unrestricted Pharmacist license in at least one of the following states: Indiana (IN), Kansas (KS), Pennsylvania (PA), Georgia (GA), or New Mexico (NM).
• Demonstrated experience practicing as a pharmacist with strong knowledge of prescription medications and clinical pharmacotherapy.
• Ability to interpret and apply plan policies, clinical criteria, FDA labeling, and evidence-based guidelines to prior authorization decisions.
• Strong clinical judgment to evaluate medical necessity, safety, and appropriateness of requested therapies.
• Proficiency in applying utilization management criteria such as step therapy, quantity limits, and formulary alternatives.
• Excellent written and verbal communication skills to convey authorization decisions and clinical recommendations clearly and professionally.
• Strong attention to detail and accuracy in documenting clinical decisions within authorization systems.
• Working knowledge of relevant regulations and standards, including CMS, NCQA, and URAC requirements.
• Ability to collaborate effectively with interdisciplinary teams, including medical directors, nurses, pharmacy technicians, and operations staff.
• Organizational and time-management skills to handle multiple prior authorization requests and meet turnaround time expectations in a remote environment.

Additional Skills & Qualifications

• Experience in prior authorization, utilization management, managed care, or similar clinical review settings.
• Familiarity with formulary management and development or maintenance of clinical criteria and policies.
• Comfort working with electronic authorization systems and clinical documentation tools.
• Experience participating in denial reviews, appeals, and peer-to-peer consultations.
• Experience in supporting quality improvement initiatives and process optimization within pharmacy or healthcare operations.

Work Environment

This is a work-from-home position that allows you to perform all responsibilities remotely. You will use electronic authorization systems and digital communication tools to review cases, document decisions, and collaborate with clinical and operations teams. The role requires reliable internet access, a professional remote workspace, and the ability to manage your time effectively while meeting established turnaround times and quality standards.

This is a Contract to Hire position based out of Phoenix, AZ.

The pay range for this position is $60.00 - $70.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

This is a fully remote position.

This position is anticipated to close on May 6, 2026.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I is embedded into our culture through:

• Hiring diverse talent
• Maintaining an inclusive environment through persistent self-reflection
• Building a culture of care, engagement, and recognition with clear outcomes
• Ensuring growth opportunities for our people

Actalent is an equal opportunity employer.

About Actalent

Actalent is a global leader in engineering and sciences services. For more than 40 years, we’ve helped visionary companies advance their goals. Headquartered in the United States, our teams span 150 offices across North America, EMEA, and APAC—with four delivery centers in India led by 1,000 extraordinary employees who connect their passion with purpose every day.

Our Bangalore, Hyderabad, Pune, and Chennai delivery centers are hubs of engineering expertise, with core capabilities in mechanical and electrical engineering, systems and software, and manufacturing engineering. Our teams deliver work across multiple industries including transportation, consumer and industrial products, and life sciences. We serve more than 4,500 clients, including many Fortune 500 brands. Learn more about how we can work together at actalentservices.com.

Salary : $60 - $70