Top 1 Prior authorization pharmacist Jobs in Westerly, Ri

Remote Pharmacist – Prior Authorization / PBM Experience
A-Line Staffing Solutions —United States
- $53 an hour
- 8 hour shift
- Background check
- Microsoft Access
- Mid-level
- Paid training
- Health insurance
Quick Apply
23h

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Remote Pharmacist – Prior Authorization / PBM Experience

A-Line Staffing Solutions -
United States

Quick Apply

Job Details

Full-time
$53 an hour
23 hours ago

Benefits

Paid training
Health insurance
Dental insurance
Vision insurance

Qualifications

Registered Pharmacist (RPh)
Record keeping
Formulary management
Medicare
Managed care
Managed care organization experience
CMS
Licensed Pharmacist (State-Specific)
CMS regulatory compliance
Pre-authorization review for utilization management
Medicare regulations
Licensed Pharmacist
Desktop applications
Productivity software
Drug utilization analysis
Quality data entry
Drug information review

Full Job Description

Remote Pharmacist – Prior Authorization / PBM Experience

Pay Rate: $53.00/hr

Start Dates

September 7
September 28

Training Requirements

Mandatory paid training is held Monday – Friday, 9:00 AM – 5:30 PM EST for approximately 8–10 weeks.
Attendance is mandatory during training. No planned vacation or scheduling conflicts are permitted during this period.
Candidates must be available for the entire training schedule before accepting the assignment.
Camera must remain on during all virtual training sessions, supervisor meetings, and team meetings.

Schedule

Business Hours:

Monday – Friday: 7:00 AM – 8:00 PM EST
Saturday & Sunday: 7:00 AM – 4:30 PM EST

Schedule Type: Set Rotation

After training, candidates will be assigned an 8-hour shift based on business needs, which will include either:

One weekend day each week, or
A rotating weekend schedule.

Job Summary

We are seeking a licensed Registered Pharmacist to support a high-volume, remote Prior Authorization and Coverage Determination team. This role is responsible for reviewing pharmacy benefit requests, interpreting clinical criteria, evaluating Medicare Part D coverage determinations, and ensuring accurate, timely decisions while maintaining compliance with regulatory requirements.

The ideal candidate has experience in Pharmacy Benefit Management (PBM), prior authorizations, managed care, or clinical pharmacy operations and thrives in a productivity-driven remote environment with strict turnaround times.

This is a Safety Sensitive position.

Key Responsibilities

Review and evaluate prior authorization and coverage determination requests.
Interpret Medicare Part D guidelines, formulary requirements, and clinical criteria.
Apply evidence-based clinical judgment using drug information resources and clinical compendia.
Ensure compliance with CMS regulations, plan policies, and pharmacy benefit guidelines.
Document case reviews accurately and maintain audit-ready records.
Manage a high-volume case queue while meeting quality and productivity standards.
Perform provider outreach as needed to obtain clinical information or clarify requests.
Navigate multiple applications simultaneously while documenting case activity.
Work independently in a fast-paced remote environment with minimal supervision.
Participate in virtual meetings, coaching sessions, and required training.

Required Qualifications

Active Registered Pharmacist (RPh) license in good standing in the state of residence.
Experience with:
Pharmacy Benefit Management (PBM)
Prior Authorizations
Coverage Determinations
Medicare Part D
Formulary management
Drug Utilization Review (DUR)
Strong understanding of CMS regulations and managed care pharmacy.
Excellent documentation and data entry skills.
Experience working in high-volume, productivity-driven environments.
Strong computer skills, including Microsoft Excel and Word.
Ability to navigate multiple computer applications using dual monitors.

Preferred Qualifications

Experience with provider outreach and clinical case review.
Retail pharmacy combined with managed care or PBM experience.
Knowledge of Microsoft Access, PowerPoint, and Visio.
Previous remote clinical review experience.

Remote Work Requirements

Candidates must have:

A dedicated, quiet workspace free from interruptions.
Wired high-speed internet with a minimum of:
25 Mbps download
5 Mbps upload
Dual-monitor capability.
Ability to remain seated and focused throughout the workday.

Additional Requirements

Virtual interviews are conducted through Microsoft Teams.
Candidates must be comfortable with extensive data entry, multitasking, and working independently while maintaining productivity standards.
Opportunity for full-time employment based on performance.

If you are interested, please send an up-to-date resume to [email protected]

ESJJP1

Pay: $53.00 per hour

Benefits:

Dental insurance
Health insurance
Vision insurance

Work Location: Remote

Quick Apply

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prior authorization pharmacist jobs in westerly, ri

Remote Pharmacist – Prior Authorization / PBM Experience

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