Remote Prior Authorization Representative Express Scripts Jobs in Atlanta, GA

Company: OptumRx

Position: Pharmacist

Locations: REMOTE across the US working EST, CST or PST

Duration: 6 – 10 months – extensions are based on business demand

• All contractors are expected to work the full assignment.
• Some assignments can convert permanent based on business demand and performance.

Start date: Rolling start dates, 8/31-11/23 – all start dates can be found on Airtable.

Schedule: Will vary depending on hiring class, information located on Air Table

• Lunch is 30 minutes; lunch is not paid.
• They will get 2, 15-minute breaks.
• Candidates with no time off request will be prioritized. 100% attendance during training is required. Candidates with more than 3 days off during the contract period will not be considered.
• Interview Process: Group interview lead by IG AM and OptumRx
• 5 Pharm Tech: 1 OptumRx Hiring Manager
• 3 RPh: 1 OptumRx Hiring Manager
• Basic Requirements for both skill sets:
• Training is for 5 weeks. Training time is TBD based on the time zone candidates will be working in Monday- Friday. This training time is subject to change.
• Shift after training is an 8-hour shift with an hour lunch. Candidate must be available as early as 5am and as late as midnight. Training requires the candidate’s camera to be on and to be at their remote home work station for the full workday.
• Candidate will work 5 days a week which may or may not include a weekend day(s). Most shifts are Monday- Friday.  5% are Sunday - Thursday and about 10% are Tuesday – Saturday.
• There may be scheduled overtime and/or working on holidays dependent on business needs.
• Pharm Techs: Average 5 hours of OT/month. 
• RPh: Average 5-20 hours of OT/month during peak season (December – January).
• Candidate must have their own home internet access.
• Expected Internet Speed: Download: ≥ 15 Mbps, Upload: ≥ 5 Mbps, Ping: ≤ 150 ms, Jitter: ≤ 30 ms
• Candidate must also have a secure workspace/office in their home, cannot be moving between locations throughout the work week.
• Candidates need to be technology savvy (Share your screen, test internet speed, open your web browser, type in a URL, favorite the web browser, navigating a second web browser, open setting and connect Bluetooth device.)
• Excellent attendance is a must.

PHARMACIST – RPh

Must Haves

-Bachelors or Doctorate of Pharmacy; Active State Pharmacist License

-Current Licensed Pharmacist within the state of work

-6+ months of customer service/customer relations with healthcare professionals

-Technology savvy - Basic proficiency with Microsoft Excel (ability to create, edit, and save a basic spreadsheet), Microsoft Word (ability to create, edit, and save a basic document) and basic proficiency with Microsoft Outlook (ability to send emails)

-Comfortable with production-based environment

-Ability to perform responsibilities and duties remotely with little to no supervision

-Comfortable in a fast-paced, high-volume workload

-Ability to be adaptable, team-oriented culture requiring flexibility and adaptability to changing business needs.

Job Description:

The Pharmacist, Prior Authorization (PA) & Appeals, is responsible for reviewing and evaluating prior authorization and appeals requests to determine coverage based on clinical guidelines, pharmacy policies, and health plan benefits. In this fast-paced, high-volume environment, the pharmacist works closely with physicians, healthcare providers, pharmacy technicians, and internal teams to gather and assess clinical information, make evidence-based coverage determinations, recommend formulary-compliant and cost-effective treatment alternatives, and ensure compliance with federal and state regulations. The role requires strong clinical judgment, attention to detail, effective communication skills, and the ability to manage competing priorities while meeting productivity and quality standards. Additionally, the pharmacist supports quality assurance initiatives, resolves provider and pharmacy inquiries, participates in process improvement efforts, and contributes to a collaborative, customer-focused team environment. Maintain full compliance with state and federal pharmacy laws, Medicare Part D, Medicaid, and commercial benefit regulations. Accurately document case decisions in accordance with internal protocols, auditing standards, and confidentiality policies.  Effectively manage case volume by organizing workload, setting daily priorities, and meeting productivity and quality benchmarks. Adapt to fluctuating demands while maintaining accuracy and professionalism under pressure.