Remote Prior Authorization Rn Jobs in Gilbert, AZ

Pay: From $53.00 per hour

Remote Prior Authorization Pharmacist – (Fully Remote)

Pay Rate: $53.00/hr.
Location: Fully Remote – Candidates may work anywhere in the continental United States except New Mexico and Colorado.

Schedule: Sun–Thurs or Tues–Sat (Candidates must work CST hours and one weekend day each week)

Shift Options:

• 10:30 AM – 7:00 PM CST
• 11:00 AM – 7:30 PM CST
• 11:30 AM – 8:00 PM CST

Start Date: October 12, 2026

Required Documents – Must Be Included at the Top of the Resume

Candidates must include the following items at the top of their resume in order to be considered:

• Active Pharmacist License (screenshot or copy)
• Internet Speed Test Screenshot
• Computer Proficiency Assessment (free online basic computer skills assessment)
• Completed Candidate Questionnaire

Position Summary

Seeking Pharmacists to join a fully remote Prior Authorization team supporting Commercial Specialty and Non-Specialty Pharmacy programs. This operations-based clinical role is responsible for evaluating prior authorization requests, applying evidence-based clinical criteria, and communicating coverage determinations to providers, members, and healthcare stakeholders.

The Pharmacist will conduct clinical reviews, collaborate with technicians and prior authorization teams, answer provider questions, and support timely decision-making while meeting service level expectations.

This role requires strong clinical judgment, prior authorization experience, excellent communication skills, and the ability to thrive in a high-volume remote environment.

Key Responsibilities

Prior Authorization Reviews (60%)

• Review and evaluate prior authorization requests
• Apply plan criteria, clinical guidelines, and policy requirements
• Verify insurance eligibility and coverage
• Consult with physicians and healthcare providers as needed
• Render approval and denial determinations
• Communicate decisions accurately and within required timelines

Team Collaboration & Provider Support (25%)

• Support technicians and prior authorization team members
• Collect clinical information needed for review
• Handle inbound and outbound provider and member calls
• Resolve escalated prior authorization cases

Clinical Knowledge & Education (10%)

• Maintain expertise in specialty and non-specialty pharmacy programs
• Stay current on disease states and drug therapies

Additional Duties (5%)

• Attend training and team meetings
• Participate in after-hours or urgent PA support as needed
• Complete special projects as assigned

Ideal Candidate Profile

• Active Pharmacist License in state of residence/practice
• BS Pharmacy required; PharmD preferred
• 2+ years of Prior Authorization experience preferred
• PBM, Managed Care, or Health Plan experience strongly preferred
• Specialty Pharmacy experience preferred
• Comfortable reviewing approximately 40 PA cases per day
• Comfortable managing approximately 50 provider calls daily
• Strong documentation and communication skills
• Proven success working remotely
• Able to work one weekend day each week
• Available for the full training period

Preferred Experience

Experience with systems such as:

• PBM and Health Plan platforms

Therapeutic specialty pharmacy experience is a plus.

Training Requirements

Training Dates: October 12, 2026 – November 25, 2026

Training Schedule:
Monday–Friday
8:00 AM – 4:30 PM CST

Candidates must attend all training sessions.

Remote Work Requirements

Candidates are required to provide their own equipment and work environment:

Internet Requirements

• High-speed broadband internet required
• Minimum:
• 25 Mbps Download
• 3 Mbps Upload
• Internet speeds must be verified via speed test screenshot
• Smartphone required for VPN authentication

Workspace Requirements

• Private workspace with a door
• Secure work environment
• No unauthorized access to confidential information
• Conversations and screens must not be visible or audible to others
• Workstation must be locked or shut down when unattended

Candidates should understand that remote assignments may convert to in-office work if business needs change.

Candidate Questionnaire (Required)

Please answer the following questions:

• What state(s) do you currently hold an active Pharmacist license in?
• How many years of Pharmacist experience do you have?
• How many years of Prior Authorization experience do you have?
• Describe your PBM, Managed Care, or Health Plan experience.
• Have you reviewed Specialty Pharmacy prior authorizations? If yes, please specify therapeutic areas.
• What pharmacy systems and platforms have you used (Caremark, RxClaim, Facets, GuidingCare, etc.)?
• What volume of prior authorization reviews did you complete daily in your most recent role?
• Have you communicated PA determinations directly with physicians, providers, or members? Please explain.
• Do you have a private workspace in your home with a door?
• Can you attend training from October 12, 2026 through November 25, 2026, Monday–Friday, 8:00 AM–4:30 PM CST, and work the assigned schedule following training? (Yes/No)

Important Dates

• Last Offer Date: 09/14/2026
• Last Acceptance Date: 09/17/2026
• Last Day to Clear Compliance: 10/02/2026
• Start Date: 10/12/2026

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Benefits:

• Dental insurance
• Health insurance
• Vision insurance