Job Description

Pharmacist

The Clinical Pharmacist is responsible for reviewing prior authorization and appeal requests by evaluating clinical documentation and making coverage determinations based on established criteria. This role involves collaborating with prescribers, pharmacies, and internal teams to obtain necessary clinical information, document decisions, and communicate outcomes. The pharmacist ensures reviews are completed accurately, efficiently, and in compliance with applicable regulatory and client requirements while contributing to process improvements within the prior authorization program.

Responsibilities

• Review prior authorization and appeal requests.
• Evaluate clinical documentation and make coverage determinations.
• Collaborate with prescribers, pharmacies, and internal teams to obtain necessary clinical information.
• Document decisions and communicate outcomes.
• Ensure compliance with applicable regulatory and client requirements.
• Contribute to process improvements within the prior authorization program.

Essential Skills

• Active pharmacist license in the state of residence (PharmD or equivalent required).
• Prior experience with prior authorization review strongly preferred.
• Ability to work efficiently in a production-driven environment.
• Strong attention to detail with a commitment to accuracy and quality.
• Excellent verbal, written, organizational, and interpersonal communication skills.
• Proficiency with technology and digital platforms (e.g., Microsoft Office, shared documentation tools, PBM systems).

Additional Skills & Qualifications

• Experience with multiple PBM platforms and payer-specific prior authorization workflows.
• Familiarity with medical benefit vs. pharmacy benefit coverage determinations.
• Exposure to appeals processing (first-level, second-level, or external review submissions).
• Working knowledge of managed care, utilization management, or health plan operations.
• Experience communicating clinical rationale to providers, pharmacies, or members.
• Comfort reviewing specialty medications (e.g., biologics, oncology, immunology, rare disease).
• Understanding of CMS, state-level, and payer regulatory requirements related to prior authorization.
• Experience using workflow, ticketing, or case management systems for clinical reviews.

Work Environment

This is a 100% work-from-home position. The role requires regular use of a computer keyboard, mouse, and calculator, with the majority of the workday spent seated at a desk.

Job Type & Location

This is a Contract position based out of Birmingham, AL.

Pay and Benefits

The pay range for this position is $50.00 - $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)

Application Deadline

This position is anticipated to close on Oct 16, 2026.

Workplace Type

This 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.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.

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