Clinical Pharmacy Reviewer (Pharmacist) - Remote

About the role

The Clinical Pharmacy Reviewer (Pharmacist) evaluates complex prior authorization requests, appeals, and medication coverage determinations to ensure clinical appropriateness and compliance with evidence-based guidelines.

Responsibilities

• Evaluate complex prior authorization requests, appeals, and medication coverage determinations for clinical appropriateness and compliance with evidence-based guidelines.
• Act as a subject matter expert in pharmacy benefit management, interpreting complex drug criteria, formulary guidelines, step therapy, and quantity limits for specialty and non‑specialty medications.
• Conduct rigorous Drug Utilization Review (DUR) and apply objective decision‑making to uphold medical necessity standards.
• Impact Dane Street's commitment to high‑quality healthcare delivery and regulatory excellence.

Requirements

• Doctor of Pharmacy (PharmD) degree from an accredited university.
• Active, unencumbered pharmacist license in any U.S. state.
• Minimum of 3 years of Prior Authorization and/or Appeals review experience within a PBM environment.
• Supply and support own internet services; maintain an uninterrupted internet connection (work‑from‑home requirement).

Skills

• Experience with Medicare Part D and Medicaid pharmacy benefits.
• Knowledge of commercial insurance pharmacy benefits and formulary management strategies.
• Knowledge of step therapy requirements, quantity limit programs, and specialty medications.
• In‑depth knowledge of Drug Utilization Review (DUR).
• Demonstrated ability to interpret and apply complex clinical guidelines.

Benefits

• Collaborative remote culture
• Professional growth opportunities
• Meaningful work supporting the healthcare industry
• Comprehensive benefits
• Great Place to Work Certified since 2021
• Commitment to employee development