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Virtual Prior Authorization Pharmacist Jobs in Puerto Rico

APS Health Care PR

PR · On-site

$16.75 - $20.25/hr

... g., prior authorization) on the PBM claims processing system to ensure that claims are correctly adjudicated. 5. Assists pharmacies claim processing. 6. Assist in the training of pharmacy ...

OncoHealth

Case Review Representative

Guaynabo, PR · On-site +1

$13 - $15/hr

... treatment review and virtual care across all cancer types. About the Role The Case Review ... Prior authorization creation * Quality Performance Program Outreach when assigned * Triage and ...

OncoHealth

Case Review Representative

Guaynabo, PR · On-site

... treatment review and virtual care across all cancer types. About the Role The Case Review ... Prior authorization creation * Quality Performance Program Outreach when assigned * Triage and ...

OncoHealth

Case Review Specialist - PR

Guaynabo, PR · On-site +1

... treatment review and virtual care across all cancer types. About the Role The Case Review ... Prior Authorization portal for all oncology drug request and treatments. Our system improves ...

OncoHealth

Case Review Specialist - PR

Guaynabo, PR · On-site

... treatment review and virtual care across all cancer types. About the Role The Case Review ... Prior Authorization portal for all oncology drug request and treatments. Our system improves ...

Insight Communications

PR · On-site

  • Medical

... prior authorizations, and benefit verifications in compliance with Puerto Rico regulations. This ... Handle inbound calls from pharmacies. * Manage administrative pre-authorizations, including cases ...

Insight Communications

PR · On-site

$14.75 - $18.25/hr

  • Medical

... prior authorizations, and benefit verifications in compliance with Puerto Rico regulations. This ... Handle inbound calls from pharmacies. * Manage administrative pre-authorizations, including cases ...

Veterans Health Administration

$124K - $400K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

This is not a virtual position. Permanent Change of Station (Relocation Assistance): Not Authorized ... prior to appointment. Applicants who refuse to be tested will be denied employment with VA.

Veterans Health Administration

$89K - $116K/yr

  • PTO

AD HOC Virtual: This is not a virtual position. Functional Statement # : 62587F Relocation ... Not Authorized EDRP Authorized: Former EDRP participants ineligible to apply for incentive.Contact ...

Veterans Health Administration

$89K - $116K/yr

AD HOC only Virtual: This is not a virtual position. Functional Statement # : 61623F Relocation ... Not Authorized EDRP Authorized: Former EDRP participants ineligible to apply for incentive.Contact ...

Veterans Health Administration

$92K - $144K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Virtual: This is not a virtual position. Relocation/Recruitment Incentives: Not Authorized ... prior to appointment. Applicants who refuse to be tested will be denied employment with VA.

Veterans Health Administration

$119K - $154K/yr

  • PTO

This is not a virtual position. Functional Statement # : 61273F Relocation/Recruitment Incentives ... Not Authorized EDRP Authorized: Former EDRP participants ineligible to apply for incentive.Contact ...

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Virtual Prior Authorization Pharmacist information

What is a virtual prior authorization pharmacist?

A Virtual Prior Authorization Pharmacist is a licensed pharmacist who works remotely to review and process prior authorization (PA) requests for medications. They evaluate clinical information submitted by healthcare providers to determine if a prescribed medication meets the requirements for insurance coverage. This role involves collaborating with providers, payers, and patients, and often utilizes electronic health records and telepharmacy systems to streamline the PA process. Virtual Prior Authorization Pharmacists help ensure that patients receive appropriate, cost-effective medications while complying with insurance policies and regulations.

How does a virtual prior authorization pharmacist typically collaborate with healthcare providers and insurance companies to ensure timely medication approvals?

As a Virtual Prior Authorization Pharmacist, you will regularly communicate with physicians, nurses, and insurance representatives to gather necessary clinical information and clarify prescription details. The role involves reviewing patient records, submitting documentation, and following up on pending authorizations to minimize delays in patient care. Effective collaboration often requires strong communication skills, attention to detail, and a proactive approach to problem-solving. You'll use secure digital platforms to coordinate these efforts, ensuring compliance with privacy regulations while streamlining the approval process.

What are the key skills and qualifications needed to thrive as a virtual prior authorization pharmacist, and why are they important?

To thrive as a Virtual Prior Authorization Pharmacist, you need a Doctor of Pharmacy (PharmD) degree, active pharmacist licensure, and strong knowledge of insurance policies and medication therapies. Familiarity with electronic prior authorization platforms, pharmacy benefit management (PBM) systems, and clinical decision support tools is typically required. Excellent communication, attention to detail, and strong organizational skills help pharmacists excel in coordinating with providers and payers remotely. These competencies are critical for ensuring accurate medication approvals, timely patient access to therapies, and compliance with regulatory standards.

What is the difference between Virtual Prior Authorization Pharmacist vs Pharmacist?

AspectVirtual Prior Authorization PharmacistPharmacist
CredentialsLicensed Pharmacist, often with certification in pharmacy or healthcareLicensed Pharmacist, with state licensure
Work EnvironmentRemote, primarily handling prior authorization requestsRetail, hospital, or clinical settings
Employer & IndustryHealth insurance companies, telepharmacy servicesPharmacies, hospitals, healthcare facilities

The Virtual Prior Authorization Pharmacist specializes in reviewing and approving prior authorization requests remotely, focusing on insurance and coverage criteria. In contrast, a Pharmacist works directly with patients in various settings, dispensing medications and providing clinical advice. Both roles require pharmacy licensure, but their work environments and daily tasks differ significantly.

What jobs can a virtual prior authorization pharmacist do remotely?

A virtual prior authorization pharmacist can perform tasks such as reviewing medication requests, verifying insurance coverage, and communicating with healthcare providers remotely. These roles typically require strong knowledge of pharmacy benefits, access to secure communication tools, and often involve flexible schedules to support healthcare providers and patients from a remote setting.

What are the most commonly searched types of Prior Authorization Pharmacist jobs in Puerto Rico?

The most popular types of Prior Authorization Pharmacist jobs in Puerto Rico are:

What are popular job titles related to Virtual Prior Authorization Pharmacist jobs in Puerto Rico?

For Virtual Prior Authorization Pharmacist jobs in Puerto Rico, the most frequently searched job titles are:

What job categories do people searching Virtual Prior Authorization Pharmacist jobs in Puerto Rico look for?

The top searched job categories for Virtual Prior Authorization Pharmacist jobs in Puerto Rico are:

What cities in Puerto Rico are hiring for Virtual Prior Authorization Pharmacist jobs?

Cities in Puerto Rico with the most Virtual Prior Authorization Pharmacist job openings:

Virtual Prior Authorization Pharmacist jobs near you
Infographic showing various Virtual Prior Authorization Pharmacist job openings in Puerto Rico as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 18% Part Time, 2% Temporary, and 2% Contract. Highlights an 94% Physical, 1% Hybrid, and 5% Remote job distribution.

Pharmacy Technician

Target Human Resources Solutions

San Juan, PR

$17.25 - $20.75/hr

Full-time

Re-posted 21 days ago

Job description

Company Overview

Our client is a leading group in the provision of mental health services in Puerto Rico, providing services in practices in the health industry, such as telemedicine and home services.

Job Summary

The Pharmacy Call Center Representative manages telephone calls and Prior Authorizations from pharmacies and providers related to pharmacy benefits, authorization requests, and drug use reviews, among others, to ensure that claims are correctly and timely adjudicated.

Responsibilities

  • Answers and manages telephone calls from pharmacies and providers in a timely, confidential, and courteous manner.
  • Documents calls and/or drug requests with complete follow-up history of the patient through electronic records.
  • Provides orientation to pharmacies regarding pharmacy benefits.
  • Performs system overrides (e.g., prior authorization) on the PBM claims processing system to ensure that claims are correctly adjudicated.
  • Assists pharmacy’s claim processing.
  • Assist in the training of pharmacy representatives.
  • Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable.
  • In addition, all other duties are assigned by the manager and/or supervisor.

Requirements

  • Pharmacy Technician Course at an accredited school.
  • Possess an active professional unrestricted Pharmacy Technician License in good standing to practice in Puerto Rico territory.
  • Availability to work rotating shifts Monday to Sunday 7:00am to 10:00pm.
  • Availability for hybrid work.

EEO
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