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Prior Authorization Pharmacist Jobs in Raleigh, NC

Spectraforce Technologies

Clinical Pharmacist 1

Raleigh, NC · On-site

$115K - $137K/yr

Reviews a completed prior authorization request received from the provider and/or reviews the ... A pharmacist will review medication requests not addressed by P&T Committee criteria or guidelines ...

Pharmacy Careers

Formulary Management Pharmacist

Raleigh, NC · On-site

$56.50 - $68/hr

Provide clinical support for utilization management, prior-authorization criteria, and step-therapy ... Active U.S. pharmacist license. * Experience: Managed care, PBM, or health-plan ideal. All ...

IN CLINIC RX LLC

Staff Pharmacist

Benson, NC · On-site

$48.25 - $57/hr

Description: Staff Pharmacist - Independent Pharmacy & Primary Care Services Benson, NC ... and prior authorization support. Promote medication adherence through patient engagement and ...

McKesson Corporation

Reimbursement Case Manager

Cary, NC · On-site

$25 - $26/hr

... prior authorization submissions with healthcare providers and payer organizations. * Monitor authorization status and proactively follow up with providers, payers, and specialty pharmacies to obtain ...

McKesson

Reimbursement Case Manager

Cary, NC · Hybrid

$25 - $26/hr

... prior authorization submissions with healthcare providers and payer organizations. * Monitor authorization status and proactively follow up with providers, payers, and specialty pharmacies to obtain ...

McKesson

Reimbursement Case Manager

Cary, NC · Hybrid

$25 - $26/hr

... prior authorization submissions with healthcare providers and payer organizations. * Monitor authorization status and proactively follow up with providers, payers, and specialty pharmacies to obtain ...

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All JobsPrior Authorization Pharmacist JobsPrior Authorization Pharmacist Jobs in Raleigh, NC

Prior Authorization Pharmacist information

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$27

$59

$72

How much do prior authorization pharmacist jobs pay per hour?

As of Aug 30, 2026, the average hourly pay for prior authorization pharmacist in Raleigh, NC is $59.21, according to ZipRecruiter salary data. Most workers in this role earn between $54.42 and $65.43 per hour, depending on experience, location, and employer.

What is a prior authorization pharmacist?

A Prior Authorization Pharmacist is a licensed pharmacist who specializes in reviewing and processing medication prior authorization requests. These requests are required by insurance companies to determine if a prescribed medication is covered under a patient's health plan. The pharmacist evaluates the medical necessity, safety, and cost-effectiveness of the medication based on clinical guidelines and insurance policies. They work closely with healthcare providers, patients, and insurance companies to ensure appropriate medication access while controlling healthcare costs. Their role helps streamline the approval process and supports optimal patient care.

What does a prior authorization pharmacist do?

A prior authorization pharmacist works specifically with the pre-approval process of filling prescribed medication orders to ensure the proper insurance coverage and efficacy for the drugs used. In this career, you work with patients as well as clinical staff, who relay prescription information from a provider. Your duties include answering questions and concerns about new medications, explaining proper usage and doses, and advising about precautions. Other responsibilities involve processing paperwork, overseeing inventory management, and supervising technicians.

What are the key skills and qualifications needed to thrive as a prior authorization pharmacist?

To thrive as a Prior Authorization Pharmacist, you need a Doctor of Pharmacy (PharmD) degree, active pharmacist licensure, and a strong understanding of insurance formularies and medication therapy management. Familiarity with pharmacy benefit management (PBM) systems, electronic prior authorization platforms, and claims processing software is essential. Strong attention to detail, effective communication, and problem-solving abilities help pharmacists navigate complex insurance criteria and advocate for patient needs. These skills ensure timely, accurate medication approvals, minimize delays in patient care, and support optimal clinical and financial outcomes.

How does a prior authorization pharmacist collaborate with healthcare providers and insurance companies to resolve medication access issues?

A Prior Authorization Pharmacist serves as a key liaison between healthcare providers, insurance companies, and patients to ensure timely access to necessary medications. They review clinical documentation, communicate with prescribers to gather additional information, and submit prior authorization requests to insurers. When challenges or denials arise, these pharmacists work closely with both providers and insurance representatives to clarify coverage criteria and appeal decisions as needed. This role requires strong communication skills and a thorough understanding of formulary policies to effectively advocate for patient care.

What is the difference between Prior Authorization Pharmacist vs Pharmacy Technician?

AspectPrior Authorization PharmacistPharmacy Technician
CredentialsDoctor of Pharmacy (PharmD) license, certificationHigh school diploma, pharmacy technician certification
Work EnvironmentHospitals, clinics, insurance companies, retail pharmaciesRetail pharmacies, hospitals, mail-order pharmacies
Job RoleReviewing insurance requests, approving prior authorizations, clinical decision-makingAssisting pharmacists, processing prescriptions, data entry

Prior Authorization Pharmacists and Pharmacy Technicians work closely in pharmacy settings, but the pharmacist handles clinical review and approval of insurance requests, while the technician supports administrative tasks. The pharmacist's role requires advanced credentials and clinical expertise, whereas the technician focuses on operational support. Both roles are essential in ensuring efficient medication management and patient care.

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The most popular types of Prior Authorization Pharmacist jobs in Raleigh, NC are:

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For Prior Authorization Pharmacist jobs in Raleigh, NC, the most frequently searched job titles are:

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The top searched job categories for Prior Authorization Pharmacist jobs in Raleigh, NC are:

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Cities near Raleigh, NC with the most Prior Authorization Pharmacist job openings:

Prior Authorization Pharmacist jobs near you
Infographic showing various Prior Authorization Pharmacist job openings in Raleigh, NC as of August 2026, with employment types broken down into 87% Full Time, and 13% Contract. Highlights an 74% In-person, 13% Hybrid, and 13% Remote job distribution, with an average salary of $123,157 per year, or $59.2 per hour.

Clinical Pharmacist - Prior Authorization

Durham, NC • On-site

Elevance Health
Health Care and Social Assistance • 10K+ employees

7.6

Company rating: 7.6 out of 10

Based on 353 frontline employees who took The Breakroom Quiz

215th of 315 rated insurance

People enjoy working here

Good employer

Recommended by students

Learn more about Elevance Healthexternal

$107K - $128K/yr

Other

Posted 5 days ago

Job description

Clinical Pharmacist - Prior Authorization

Pharmacist Clinical

****Seeking Pharmacists who are licensed in North Carolina or Kansas!****

LOCATION: This position is virtual eligible. You should be within a reasonable distance of one of our offices.

HOURS: General business hours, Monday through Friday

Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Clinical Pharmacist (Prior Authorization) is responsible for managing the selection and utilization of pharmaceuticals and supports core clinical programs such as DUR, DIS and formulary management.

How you will make an impact:

  • Researches and synthesizes detailed clinical data related to pharmaceuticals.
  • Prepares and presents therapeutic class reviews and drug monograph information to the Pharmacy and Therapeutics Committee.
  • May review and approve or deny coverage for pharmaceuticals (as permitted by state/federal law or state/federal program contracts) based on medical necessity criteria, and coordinates with internal stakeholders or health plan medical directors as needed.
  • Serves as a clinical resource to other pharmacists on areas such as prospective, inpatient and retrospective DURs and provides dosage conversion and clinical support for therapeutic interventions.
  • Prepares information for network physicians.

Required Qualifications

  • Requires BA/BS in Pharmacy.
  • Minimum of 2 years of managed care pharmacy (PBM) experience or residency in lieu of work experience; or any combination of education and experience, which would provide an equivalent background.
  • Requires a registered pharmacist.
  • Must possess an active unrestricted state license to practice pharmacy as a Registered Pharmacist (RPh).
  • For associates working within Puerto Rico who are member or patient facing either in a clinical setting or in the Best Transportation unit, a current PR health certificate and a current PR Law 300 certificate are required for this position.

Preferred Qualifications

  • PharmD very strongly preferred.
  • You must be licensed in Kansas or North Carolina.
  • Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Job Level: Non-Management Exempt

Workshift: Job Family: MED > Licensed/Registered Pharmacist/Pharmacy Technician

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About Elevance Health

Sourced by ZipRecruiter

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Indianapolis, IN, US

Year founded

2004

Social media

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Benefits

Hours and flexibility

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