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•Pharmacist license in OK, IN, KS, PA, GA, or NM.

The primary role of a pharmacist is to conduct the final prior authorization review for the Appeals Department. This involves evaluating completed prior authorization requests, verifying member information, and ensuring the appropriateness of pharmacy technician recommendations.

Responsibilities

+ Review completed prior authorization requests received from providers.

+ Assess pharmacy technician's recommended denial, suggested formulary alternatives, comments, and attachments for appropriateness.

+ Verify member's ID number, date of birth, and eligibility in the health plan system.

+ Record carrier and group number, if applicable.

+ Check for previous prior authorization decisions and verify prescription and health plan benefits.

+ Evaluate prescription claim history and review chart notes and lab values.

+ Identify provider specialty when appropriate and apply Medical Policy Criteria to requests.

+ Use professional clinical judgment to review requests on a case-by-case basis.

+ Develop and draft criteria for non-formulary medication requests not addressed by P&T Committee guidelines.

+ Research and contribute drug references and clinical information to facilitate prior authorization review.

+ Communicate with physicians about prior authorization, non-formulary drugs, plan benefits, exclusions, quantity limits, age restrictions, and formulary alternatives.

+ Retrieve and collect data through available reporting resources.

+ Compile data for reporting purposes, including drug utilization of non-formulary drugs and overturned IPS recommended denials.

+ Audit pharmacy claims greater than $200.00 and suggest additions or deletions to the formulary.

+ Support the National P&T Committee.

+ Comply with state and federal drug laws by monitoring nursing unit inspections, maintaining records for controlled substances, and removing outdated and damaged drugs from inventory.

Essential Skills

+ Doctor of Pharmacy (PharmD) or Bachelor of Science Pharmacy degree.

+ Current pharmacist license in good standing with the State Board of Pharmacy.

+ Experience with prior authorizations and pharmacy benefits management.

+ Managed care experience and proficiency in data entry and Microsoft applications.

Additional Skills & Qualifications

+ Experience working remotely.

+ Familiarity with Medicaid.

Work Environment

This is a 100% remote position, requiring a dedicated workspace at home.

Working hours are Monday through Friday, from 9 am to 6 pm EST, with no overtime.

There are rotating weekends and holidays.

Training occurs from 10 am to 6:30 pm EST, Monday through Friday.

Pay and Benefits

The pay range for this position is $60.00 - $65.00/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:

• Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • 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 Nov 3, 2025.

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 due to a disability, please email [email protected] (%[email protected]) for other accommodation options.