Pharmacist Operations Advisor

Date Posted: 09/03/2025 Hiring Organization: Rose International Position Number: 487989 Industry: Pharmaceutical/Healthcare Job Title: Pharmacist Operations Advisor Job Location: Remote, USA Work Model: Remote Shift: Sunday to Thursday or Tuesday to Saturday 10:30 AM to 7:00 PM CST Employment Type: Temporary FT/PT: Full-Time Estimated Duration (In months): 7 Min Hourly Rate ($): 50.00 Max Hourly Rate ($): 53.00 Must Have Skills/Attributes: Clinical Data management, Microsoft Excel, Microsoft Word, Pharmacy Experience Desired: Experience with prior authorization (PA) reviews or clinical case review (2+ yrs); Active pharmacist license in the state of practice/residence (1+ yrs) Required Minimum Education: Bachelor's Degree Preferred Education: Ph.D. / Doctorate Required Certifications/Licenses: Pharmacist license **C2C is not available** Job Description Required Education • Bachelor's Degree - BS Pharmacy • Active pharmacist license in the state of practice/residence. Preferred Education • Doctorate - PharmD. Required License/Certification • Active pharmacist license. Required Qualifications/Skills/Experience • Prior experience with prior authorization (PA) reviews or clinical case review in a high-volume or production setting • Direct experience processing PA requests, ideally with a commercial or specialty pharmacy • Strong documentation of meeting service level agreements (SLAs) or production targets • Ability to multitask using multiple technology platforms and clinical resources • Proficiency with Microsoft Office (Excel and Word) • Experience using multiple clinical and administrative systems simultaneously • Effective written and verbal communication skills • Ability to collaborate with cross-functional clinical and non-clinical staff • Comfort handling phone-based interactions with providers and patients. Preferred Qualifications/Skills/Experience • Retail pharmacy experience (not required, but candidates with this background have been successful in the role). Pharmacist/Clinician Overview • Operation-based role that conducts criteria-based and clinical review of medical data for prior authorization in alignment with policy and procedure • Applies clinical knowledge to plan and approve criteria for case reviews • Works within Client-supported systems to handle inbound calls from physicians or members regarding pending, approved, or denied prior authorizations • Provides internal support to the Prior Authorization team and the Member Services department • Provides on-call, after-hours availability for urgent prior authorization requests as needed • Position is remote, available to candidates anywhere in the continental U.S. except New Mexico and Colorado • Requires a broadband internet connection and a smartphone Job Duties • Evaluate and review prior authorization requests, render coverage determinations based on clinical criteria, and plan design • Verify insurance coverage and eligibility, interpret clinical guideline criteria, and consult with healthcare providers • Communicate approval and denial decisions promptly to providers, employers, patients, and other stakeholders • Collaborate with technicians and team members to process referrals, answer clinical questions, and collect required data • Handle inbound/outbound calls to facilitate requests, answer inquiries, and resolve escalations • Maintain professional and technical knowledge of drug and disease states for specialty and non-specialty programs • Attend training sessions, development meetings, and provide after-hours/on-call support as required • Perform other related duties as assigned. Essential Functions • Regular and predictable attendance • Ability to work mandatory overtime or extended work weeks as needed • Compliance with departmental, company, state, and federal requirements • Adherence to policies and procedures • Ongoing participation in training and development meetings. **Only those lawfully authorized to work in the designated country associated with the position will be considered. ** **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client's business needs and requirements. ** Benefits: For information and details on employment benefits offered with this position, please visit here. Should you have any questions/concerns, please contact our HR Department via our secure website. California Pay Equity: For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations' website here.

Created: 2025-09-24