Prior Authorization Pharmacist

Job Title: Clinical Pharmacist u2013 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. Job Type & Location This is a Contract to Hire position based out of Houston, TX. Pay and Benefits 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: u2022 Medical, dental & vision u2022 Critical Illness, Accident, and Hospital u2022 401(k) Retirement Plan u2013 Pre-tax and Roth post-tax contributions available u2022 Life Insurance (Voluntary Life & AD&D for the employee and dependents) u2022 Short and long-term disability u2022 Health Spending Account (HSA) u2022 Transportation benefits u2022 Employee Assistance Program u2022 Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on May 22, 2026. About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email for other accommodation options. San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records. Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.

Created: 2026-05-11