*Clinical Pharmacist - Prior Authorization

Job ID: 26-149800Position Type: Temporary Location: RemoteWork Type: FulltimeEst. Pay Range: $63.00/hr. To $65.75/hr. All-inclusive on W2Position 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.

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.

Education:

• Bachelor's degree in pharmacy or Pharm D. Also required with at least two years experience as a pharmacist.
• Must have an active license in good standing.

Employee Benefits: At LanceSoft, full time regular employees who work a minimum of 30 hours a week or more are entitled to the following benefits: Four options of medical Insurance Dental and Vision Insurance 401k Contributions Critical Illness Insurance Voluntary Permanent Life Insurance Accident Insurance Other Employee Perks LanceSoft is a certified Minority Business Enterprise (MBE) and an equal opportunity employer. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws. This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. LanceSoft makes hiring decisions based solely on qualifications, merit, and business needs at the time.