Remote PBM Prior Authorization Pharmacist (Must be licensed in North Carolina)

Company: A-Line Staffing Solutions
Location: Charlotte
Posted on: April 21, 2025

Job Description:

Job Title: Remote PBM Prior Authorization Pharmacist

All potential candidates should read through the following details of this job with care before making an application.

Pay: $53 an hr - Bi-weekly

Job Type: Remote (Must be licensed in North Carolina but can live in any state)

Start date: 06/12/25

Shift Options:

Shift 11am to 730pm EST


Schedule Training: Mon - Fri 8am - 430 PM EST Starting 06/2/2025. Training will be 4 weeks



Remote PBM Prior Authorization Pharmacist Overview:

This position is for a Clinical Pharmacist working in the Prior Authorization team. This Pharmacist will:
Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design.
Includes verifying insurance coverage and eligibil -ity, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols.
One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval & denial management processes.
Collaborate with the technicians and prior authorization team members to process refer -rals, including answering clinical questions and collecting appropriate clinical/medical data needed to perform clinical assessments and reviews as per the health plan/employer- agreed criteria within the designated service level agreements.
Performs and handles in - bound and outbound phone calls with technicians, prior authorization team members, physi -cians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations.
Maintain professional and technical knowledge of drug and disease states for the Specialty and Non-Specialty Pharmacy programs administered within the Commercial Prior Authorization and Case Review Unit (CRU) line of business.
Perform other related projects and duties as assigned, including attending training ses -sions and development meetings, and providing on-call and after-hours pharmacist avail - ability as needed.

Remote PBM Prior Authorization Pharmacist Qualifications:

Hold and maintain an active, unencumbered Pharmacist license in North Carolina.
Position requires proficiency with computer skills which include multitasking, navigating multiple systems, and keyboarding.
Experience using MS Office, other Windows - based computer applications, web based processing and telephony programs.
Minimum 2 years' recent experience reviewing and processing prior authorizations against health plan criteria for a determination in a specialty/skilled clinical setting i.e., specialty medical office or Pharmacy Benefits Manager (PBM)

Remote PBM Prior Authorization Pharmacist Benefits:

Benefits are available to full-time employees after 90 days of employment and include health, optical, dental, life, and short-term disability insurance.
A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates.

How to Apply:

If you are interested in this position, please apply OR submit your resume to:

Saw Hlaing - shlaing@alinestaffing.com - 412-790-5425
Remote working/work at home options are available for this role.

Keywords: A-Line Staffing Solutions, Burlington , Remote PBM Prior Authorization Pharmacist (Must be licensed in North Carolina), Healthcare , Charlotte, North Carolina