Description
Candidates will be reviewing Commercial members' Utilization Management (UM) requests (i.e., formulary exceptions, prior authorization, step therapy, quantity limit exceptions). Client-specific criteria are referenced to determine if a prior authorization can be approved or denied. The work is detail-oriented, and candidates will be expected to provide clinical judgement and communication.
Responsible for the clinical evaluation for coverage determination requests for PA or other UM programs, including quantity limits, step therapy, formulary exception and tier exception, and includes consideration of the denial language and appropriateness of the decision as it pertains to the clinical content of the case and the intent of the individual client's pre-approved criteria
Accountable for direct consultation with health care providers or members concerning non-formulary and clinical product coverage issues
Collaborate with team members to promote consistency of decisions across the pharmacist team
Other duties as assigned
Interaction level with Management/Team Members:
Role is primarily independent with routine structured touchpoints.
Regular communication with supervisors, senior pharmacists, technicians, and other team members via Teams messaging platforms, phone and video calls.
o Cameras/video calls used for: Training sessions, Team meetings, routine 1:1s with supervisors.
senior Pharmacists are available throughout the day to support clinical questions and provide guidance.
Success Metrics
Productivity: Complete cases in an efficient manner consistent with the team average.
Accuracy: Achieve and maintain a quality score (error-free rate) of 95%.
Accountability: Demonstrate a strong attendance record and excellent communication skills.
Team/culture fit: receptive to feedback, focus, problem-solving, accuracy, learning agility, sound clinical judgement, ability to work independently while still finding ways to collaborate with team-player attitude.
Computer Skills: Quickly learn new systems; comfortable with multi monitor setups; adept at navigating multiple platforms, using available resources, Microsoft applications, and AutoHotkey.
This will be with the Commericial line of business.
All new pharmacists are considered as potential long-term employees with a hope to hire on as permanent employees in the future, but cannot guarantee a timeline on conversion and contracts are evaluated every 6 months for extension.
Skills
Pharmacist, Retail, Clinical, Pharmacy Benefits Management, Pharmacy, Prior authorization, Pharmd, Compounding
Top Skills Details
Pharmacist,Retail,Clinical
Additional Skills & Qualifications
Qualifications/years of experience:
Doctor of Pharmacy (PharmD) or equivalent
2+yrs experience working in a retail environment
Current pharmacist license in good standing with the State Board of Pharmacy in the State where the candidate is licensed. *Verify by searching (State) State Board of Pharmacy, ex: Oklahoma State Board of Pharmacy (will need license number from pharmacist). Also provide transparency on any disciplinary action taken on license which is provided in the search.
Must Haves:
Ability to prioritize tasks and manage multiple projects simultaneously.
Drive to deliver results orientation.
A motivated self-starter who does not need constant direction or feedback to drive results.
Ability to make clinical decisions independently
Flexibility to change and resourceful
Technology Requirements:
Proficient with learning new computer systems, basic IT trouble shooting and using multiple monitors
Word and Excel
Ability to @type 45+ WPM
Additional Preferred Requirements:
Previous PBM or Case/Care Management experience. Retail experience (ex: CVS, Walgreens, etc.) highly preferred vs Hospital experience
Experience Level
Entry Level
Job Type & Location
This is a Contract to Hire position based out of Dallas, TX.
Pay and Benefits
The pay range for this position is $55.00 - $55.00/hr.
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)
Workplace Type
This is a fully remote position.
Application Deadline
This position is anticipated to close on May 13, 2026.
Diversity, Equity & Inclusion
At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I is embedded into our culture through:
Hiring diverse talent
Maintaining an inclusive environment through persistent self-reflection
Building a culture of care, engagement, and recognition with clear outcomes
Ensuring growth opportunities for our people
Actalent is an equal opportunity employer.
About Actalent
Actalent is a global leader in engineering and sciences services. For more than 40 years, we've helped visionary companies advance their goals. Headquartered in the United States, our teams span 150 offices across North America, EMEA, and APAC-with four delivery centers in India led by 1,000+ extraordinary employees who connect their passion with purpose every day.
Our Bangalore, Hyderabad, Pune, and Chennai delivery centers are hubs of engineering expertise, with core capabilities in mechanical and electrical engineering, systems and software, and manufacturing engineering. Our teams deliver work across multiple industries including transportation, consumer and industrial products, and life sciences. We serve more than 4,500 clients, including many Fortune 500 brands. Learn more about how we can work together at actalentservices.com.
