Hiring for Clinical Pharmacist - Prior Authorization Remote role
Job ID: 26-81671 Job Title: ‘Clinical Pharmacist - Prior Authorization’ Position Type: Full-Time Contract Role
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Location: Remote Work Type: Remote
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Est. Pay Range: $65.00/Hour to $70.00/Hour on W2 (USD) Schedule: Monday-Friday 10 AM-6:30 PM AZ Time (Mon-Fri 8AM-4:30 PM AZ Time [training (8 weeks)] Description: Medicaid Prior Authorization Pharmacist. This is a Clinical Pharmacist Position supporting Medicaid Prior Authorization. The position is remote. An active AZ or TX pharmacist license that is in good standing is required. Must be ok with these hours (AZT time zone) Duties Review, assess, adjudicate medication prior authorization requests for medical necessity, clinical appropriateness, and formulary compliance. Apply evidence-based clinical guidelines, drug compendia, FDA labeling, and plan-specific criteria to authorization decisions. Evaluate patient-specific factors including diagnosis, laboratory results, prior therapy, dosing, contraindications, and comorbid conditions. Authorize, modify, or deny medication requests and document clinical rationale clearly and accurately. Collaborate with pharmacy technicians, nurses, medical directors, and other clinical staff to resolve complex cases. Support peer-to-peer reviews and prepare clinical summaries when escalation is required. Ensure compliance with state and federal regulations, accreditation standards (e.g. NCQA, URAC), and internal audit requirements. Maintain productivity, turnaround time, and quality benchmarks for prior authorization processing. Document all activities accurately within prior authorization and pharmacy management systems. Experience Active and unrestricted AZ or TX pharmacist license. Experience with clinical decision-making while applying evidence based clinical guidelines/criteria; utilizing formularies/preferred drug lists. Experience working in a high production team environment. 3+ years experience working as a pharmacist. Knowledge of clinical program components, formulary designs, and prescription benefit trends. Position Summary The Prior Authorization Pharmacist is responsible for reviewing and evaluating medication prior authorization requests to ensure appropriate, safe, and cost-effective therapy in accordance with clinical guidelines, regulatory requirements, and organizational policies. This role applies clinical judgement to support optimal patient outcomes while balancing utilization management objectives. Education Bachelor's degree in pharmacy or Pharm D. required with at least two years experience as a pharmacist. Must have an active license in good standing. If you believe you're qualified for this position and are currently in the job market or interested in making a change, please give me a call as soon as possible at 571 678 0714. Remote Skills: Accreditation Standards, Adjudication, Benchmarking, Biotech and Pharmaceutical, Clinical Practices/Protocols, Clinical Study Publications, Clinical Support, Clinical Validation, FDA (Food and Drug Administration), Federal Laws and Regulations, Formulary, Internal Audit, Maintain Compliance, Medicaid, Medications, National Committee for Quality Assurance (NCQA), Nursing, Patient Assessment, Patient Care Authorizations, Pharmacy, Production Systems, Regulatory Requirements, State Laws and Regulations, Team Player, Utilization Management, Utilization Review Accreditation Commission (URAC) About the Company: LanceSoft Inc We are a $125 Million, NMSDC-certified Minority & Woman owned Workforce Solutions Company headquartered in the DC metro area with presence across US with global presence - Canada, Mexico, India, UK, Malaysia, Indonasia, Hongkong, Singapore, UAE. We are specialized in providing Workforce Solutions, SOW project delivery, Engineering Solutions, Creative Services. We currently support 100+ Fortune companies globally and across multiple industry segments. We are currently supporting several massive programs across industry segment nationally/globally (Intel, Ally, AMD, QUALCOMM, Morgan Stanley, Kraft/ Mondelez, MNP, Amdocs, Dell, SanDisk, Medtronic, Becton Dickinson, GE, Lockheed Martin, UTC, L-3 Communications, Caterpillar, BMW, Mercedes Benz, National Grid, Dominion, Energy Future Holdings, PSEG, 3M, Fidelity, Aetna, Humana, Johnson & Johnson, Pfizer, Merck etc). All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender, identity, national origin, disability, or protected veteran status. Company Size: 2,000 to 2,499 employees Industry: Staffing/Employment Agencies Founded: 2000 Website: http://www.lancesoft.com/ Apply To This Job