Prior Authorization Pharmacist

Soleo Health

. Perform comprehensive clinical reviews and manage prior authorization requests for specialty pharmacy and infusion therapies .

Posted 10/23/2026full-timeRemote • Texas • United StatesJuniorMid-Level💰 $110,000 - $130,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in prior authorization processes, clinical documentation assessment, and specialty pharmacy management. Proficient in navigating payer policies and optimizing patient access through effective communication and collaboration.

Highest-signal resume keywords

Doctor Of Pharmacy (PharmD)Active U.S. Pharmacist LicensePrior Authorization ExperienceClinical Decision-Making SkillsPharmacy Benefit Systems Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical ReviewPrior Authorization ManagementDrug Therapy UnderstandingFormulary ManagementClinical Guidelines AssessmentDocumentation SkillsAnalytical SkillsUtilization ManagementSpecialty Medications ReviewClaims Systems Familiarity

Soft Skills

Strong Communication SkillsAbility To Manage Multiple PrioritiesHigh Level Of IntegrityCollaboration SkillsFast-Paced Environment Adaptability

Tools & Technologies

Prior Authorization PlatformsElectronic Documentation SystemsPA Automation ToolsPharmacy InformaticsMicrosoft WordMicrosoft ExcelMicrosoft PowerPoint

Certifications & Qualifications

Active U.S. Pharmacist LicenseMulti-State Pharmacist Licensure (Preferred)

Industry Keywords

PBMManaged CarePayer Pharmacy OperationsClinical Criteria DevelopmentUtilization Management ProgramsSpecialty PharmacyInfusion TherapiesEvidence-Based Appeal LettersPatient Access OptimizationRegulatory Requirements

About the role

Key responsibilities & impact

Perform comprehensive clinical reviews and manage prior authorization requests for specialty pharmacy and infusion therapies
Assess clinical documentation against payer-specific medical necessity criteria, coverage policies, and clinical guidelines
Prepare, submit, and track prior authorization requests to PBMs and health plans
Communicate with PBMs and health plans to clarify clinical information, provide additional documentation, and resolve authorization issues
Mitigate denials by addressing rejections in real time through live outreach to PBMs and payers
Create and submit evidence-based appeal letters with clinical rationale, literature support, and policy alignment
Collaborate with the patient access team and internal stakeholders to obtain documentation and optimize patient access to therapy
Monitor authorization outcomes and track performance metrics to identify delays, barriers, or trends
Stay current with payer policies, clinical guidelines, and regulatory requirements
Identify workflow and training optimization opportunities and contribute to process improvement initiatives

Requirements

What you’ll need

Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy from an accredited institution
Active, unrestricted U.S. pharmacist license
2+ years of experience in prior authorization, utilization management, PBM, managed care, or payer pharmacy operations
Strong understanding of drug therapy, clinical guidelines, specialty medications, and formulary management
Excellent analytical, clinical decision-making, and documentation skills
Proficiency in pharmacy benefit systems, prior authorization platforms, and electronic documentation
Strong written and verbal communication skills
Ability to manage multiple priorities and perform in a fast-paced environment with strict timelines
High level of integrity and ability to handle confidential or sensitive clinical information
Multi-state pharmacist licensure preferred
Experience reviewing specialty medications, biologics, or complex therapy classes preferred
Prior PBM or health plan experience preferred
Experience with clinical criteria development, formulary management, or utilization management programs preferred
Familiarity with claims systems, PA automation tools, or pharmacy informatics preferred
Competent in the use of Word, Excel, and PowerPoint
Must be able to communicate effectively with all levels of organization within Soleo Health
Must enthusiastically support Soleo Health’s philosophy and goals

Benefits

Comp & perks

Competitive Wages
401(k) with a Match
Referral Bonus
Paid Time Off
Great Company Culture
Annual Merit Based Increases
No Weekends or Holidays
Paid Parental Leave Options
Affordable Medical, Dental, & Vision Insurance Plans
Company Paid Disability & Basic Life Insurance
HSA & FSA (including dependent care) Options
Education Assistance Program