AL · Remote
$57 - $58/hr
Seeking licensed Prior Authorization Pharmacists with PBM (Pharmacy Benefit Management) experience for a fully remote contract opportunity. The Pharmacist Operations Advisor will be responsible for ...
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AL · Remote
$57 - $58/hr
Seeking licensed Prior Authorization Pharmacists with PBM (Pharmacy Benefit Management) experience for a fully remote contract opportunity. The Pharmacist Operations Advisor will be responsible for ...
Delaware, OH · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
Delaware, OH · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
Three Rivers, MI · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
Three Rivers, MI · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
OR · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
OR · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
New York, NY · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New York, NY · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
Florida, NY · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
Florida, NY · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
Baltimore, MD · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
Baltimore, MD · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
Gaithersburg, MD · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
Gaithersburg, MD · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
Ohio, IL · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
Ohio, IL · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
Shelbyville, KY · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
Shelbyville, KY · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
California, MD · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
California, MD · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
Indiana, PA · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
Indiana, PA · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
Columbia, SC · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
Columbia, SC · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
Virginia, IL · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
Virginia, IL · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
Michigan, ND · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
Michigan, ND · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
Tennessee, IL · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
Tennessee, IL · Remote
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
New
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
$155K - $175K/yr
... PBM industry, Medicaid, Medicare, and health plans * Experience with contract language and risk mitigation concepts Travel Requirements: Up to 10% of the time. Work is generally performed in a remote ...
| Aspect | Contract Remote Pbm | Contract Remote Pharmacist |
|---|---|---|
| Credentials | Licensing, certification in pharmacy benefit management | State pharmacy license, certification (e.g., PTCB) |
| Work Environment | Remote, healthcare/insurance industry | Remote, healthcare/pharmacy industry |
| Employer & Industry Usage | Health plans, PBMs, insurance companies | Pharmacy chains, hospitals, insurance companies |
| Common Search & Comparison | Yes | Yes |
Contract Remote Pbm roles focus on managing pharmacy benefits, requiring knowledge of benefit design and healthcare policies, while Contract Remote Pharmacist roles involve direct pharmacy practice, medication review, and dispensing. Both are remote healthcare positions but differ in responsibilities and industry focus.
Job Title: Pharmacist Operations Advisor – Prior Authorization (Remote)
Location: Remote (Excludes residents of New Mexico and Colorado)
Start Date: September 15, 2025
Duration: 5 months (09/15/2025 to 02/13/2026)
Seeking licensed Prior Authorization Pharmacists with PBM (Pharmacy Benefit Management) experience for a fully remote contract opportunity. The Pharmacist Operations Advisor will be responsible for performing clinical reviews of prior authorization requests and supporting care delivery across Commercial Prior Authorization Unit.
Training:
Dates: September 15, 2025 – October 31, 2025
Time: Monday to Friday, 8:00 AM – 4:30 PM CST
Post-Training Shift Options (based on business need):
Sunday–Thursday or Tuesday–Saturday
10:30 AM – 7:00 PM CST
11:00 AM – 7:30 PM CST
11:30 AM – 8:00 PM CST
Please indicate preferred shift at the top of the resume.
Conduct clinical and criteria-based reviews of prior authorization requests.
Verify insurance coverage, eligibility, and plan design applicability.
Collaborate with PA technicians and other healthcare providers to ensure timely case resolution.
Handle inbound/outbound calls from physicians, healthcare providers, and members.
Ensure compliance with departmental protocols, approval/denial processes, and privacy guidelines.
Maintain up-to-date clinical and technical knowledge for CVS Specialty and Non-Specialty programs.
Participate in training, development sessions, and on-call coverage as needed.
Active Registered Pharmacist License in the state of residence.
1–3 years of experience working in a PBM and/or Prior Authorization setting (required).
Solid understanding of clinical guidelines and managed care principles.
Proficiency with Microsoft Office (Excel and Word; Access, Outlook, and Visio preferred).
Strong multitasking ability using multiple applications simultaneously.
Excellent written, verbal, and interpersonal communication skills.
Proven problem-solving and attention to detail.
Ability to work independently and maintain confidentiality of PHI.
Required: BS in Pharmacy + Active Pharmacist License
Preferred: Doctorate of Pharmacy (PharmD)
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Recruiting and staffing services
501 - 1,000 Employees
Addison, TX, US
2007
