Job Title: Pharmacist IJob DescriptionThis remote Pharmacist I role focuses on reviewing Utilization Management requests for Medicaid members, including formulary exceptions, prior authorizations, step therapy, and quantity limit exceptions. You will apply client-specific criteria and clinical judgment to determine whether to approve or deny prior authorization requests while maintaining high accuracy and attention to detail. The position involves frequent communication with prescribers and providers, primarily via fax and electronic submissions, with a moderate volume of phone calls and no direct patient interaction. This opportunity is ideal for pharmacists seeking to transition away from retail settings into a pharmacy benefits management and managed care environment, with potential for future cross-training and long-term employment.
Responsibilities
- Review Utilization Management requests for Medicaid members, including formulary exceptions, prior authorization, step therapy, and quantity limit exception requests.
- Apply client-specific criteria, clinical guidelines, and professional judgment to determine whether prior authorization requests should be approved or denied.
- Document all clinical decisions clearly and accurately in the appropriate systems, ensuring compliance with internal policies and regulatory requirements.
- Communicate with prescribers and providers by phone, fax, and electronic systems to clarify information, obtain additional clinical details, and explain determinations, handling approximately 510 calls per day.
- Use pharmacy benefits management tools and systems to process requests efficiently while maintaining high quality and attention to detail.
- Manage a steady workflow of electronic and fax submissions, prioritizing cases based on urgency, complexity, and established turnaround times.
- Independently make clinical decisions within defined criteria and escalate complex or ambiguous cases as appropriate.
- Maintain productivity, accuracy, and quality metrics as defined by leadership, including production volume, work quality, and attendance standards.
- Adapt to evolving policies, procedures, and criteria, incorporating updates into daily decision-making and documentation.
- Participate in required training sessions and apply new knowledge to review specialized cases when opportunities arise (such as oncology, hepatitis C, and other complex conditions).
- Collaborate with internal teams and leadership to support consistent application of criteria and best practices across the Utilization Management function.
- Provide professional, courteous, and timely communication to providers and internal stakeholders to support efficient case resolution.
- Maintain confidentiality of member information and adhere to all applicable privacy and security regulations.
- Potentially cross-train and support other departments, such as Medication Therapy Management or Call Center Counseling, if opportunities are available and performance criteria are met.
- Work assigned shifts, including evenings and rotating weekends, and comply with scheduling requirements, blackout periods, and holiday coverage expectations.
Essential Skills
- Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy degree.
- Current pharmacist license in good standing with the applicable State Board of Pharmacy where the candidate is licensed.
- Minimum of 2 years of experience as a licensed pharmacist in retail, managed care, or clinical pharmacy.
- Experience with pharmacy benefits management or prior authorization processes.
- Ability to make independent clinical decisions within defined criteria and professional standards.
- Strong ability to prioritize tasks and manage multiple cases or projects simultaneously.
- Results-driven mindset with a demonstrated drive to deliver outcomes and meet performance metrics.
- Self-motivated and able to work independently without constant direction or feedback.
- Flexibility and resourcefulness in adapting to changing policies, processes, and workload demands.
- Proficiency in learning and using new computer systems and working with multiple monitors.
- Basic IT troubleshooting skills for common work-from-home technology issues.
- Proficiency with Microsoft Word and Excel.
- Ability to type at least 35 words per minute.
- Clear, professional verbal and written communication skills for interacting with providers and documenting decisions.
- High level of attention to detail and accuracy in clinical review and documentation.
Additional Skills & Qualifications
- Previous pharmacy benefits management (PBM) experience strongly preferred.
- Previous case management or care management experience is preferred.
- Retail pharmacy experience is highly preferred compared to hospital pharmacy experience.
- Experience in compounding pharmacy practice is beneficial.
- Familiarity with Medication Therapy Management (MTM) programs is an advantage.
- Experience in call center or telephonic counseling environments is helpful.
- Comfort working in a production-driven environment with defined quality and productivity expectations.
- Strong organizational skills and the ability to manage time effectively in a remote setting.
- Openness to cross-training and supporting multiple pharmacy-related functions as business needs evolve.
- Interest in reviewing specialized clinical cases such as oncology, hepatitis C, and other complex conditions when training opportunities are available.
Work EnvironmentThis is a fully remote, work-from-home position based in the United States (excluding certain locations as defined by company policy). Pharmacists work primarily in a digital environment, handling fax and electronic submissions and using multiple monitors, pharmacy benefits management platforms, and standard productivity tools such as Microsoft Word and Excel. Core operating hours span from 8:00 a.m. to 11:00 p.m. Eastern Time. After training, pharmacists typically work five 8-hour shifts Monday through Friday, with 23 days scheduled from 9:00 a.m. to 5:30 p.m. Eastern Time and 23 days from 2:30 p.m. to 11:00 p.m. Eastern Time. There are rotating weekend shifts, generally one out of every four weekends (with the possibility of increased frequency during peak season), usually scheduled from 9:00 a.m. to 5:30 p.m. Eastern Time on Saturdays and potentially Sundays, with a weekday off provided in exchange. The schedule is generally published at least two weeks in advance. Initial training is conducted remotely, Monday through Friday from 9:00 a.m. to 5:30 p.m. Eastern Time for approximately three weeks. Contractors may use up to 120 hours of unpaid time off per year, subject to an annual bidding process based on seniority. There is a blackout period during which time off is not permitted from late November through early January, and pharmacists may be required to work on certain holidays such as Christmas Eve, New Years Eve, and New Years Day, with Christmas Day off. The role is production- and quality-focused, with performance evaluated every six months and all new pharmacists considered as potential long-term employees. After conversion to a permanent role, employees receive a generous vacation allotment and a comprehensive benefits package. Dress code for this role is typical of a professional remote environment, with expectations of a neat, presentable appearance for any video or external interactions. Job Type & LocationThis is a Contract position based out of Eagan, MN. Pay and BenefitsThe pay range for this position is $55.00 - $55.00/hr. Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits
available for this temporary role may include the following:
Medical, dental & vision Critical Illness, Accident, and Hospital 401(k) Retirement Plan Pre-tax and Roth post-tax contributions available Life Insurance (Voluntary Life & AD&D for the employee and dependents) Short and long-term disability Health Spending Account (HSA) Transportation benefits Employee Assistance Program Time Off/Leave (PTO, Vacation or Sick Leave) Job Type & LocationThis is a Contract position based out of Eagan, MN. Application DeadlineThis position is anticipated to close on Nov 20, 2026. Workplace TypeThis is a fully remote position.About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 20,000 consultants and 5,000 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. We are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a ClearlyRated Best of Staffing® winner for both client and talent service.
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