Prior Authorization Pharmacist

Soleo Health•Frisco, TX

13d•Remote

About The Position

Soleo Health is seeking a Prior Authorization Pharmacist to support its Specialty Infusion Pharmacy remotely in the USA. The pharmacist performs comprehensive clinical reviews and manages prior authorization requests for specialty pharmacy and infusion therapies. The role assesses clinical documentation against payer-specific medical necessity criteria, communicates with Pharmacy Benefit Managers (PBMs) and health plans, and supports denial prevention and resolution through real-time outreach and evidence-based appeals. The pharmacist collaborates with internal teams to improve patient access to therapy and contributes to workflow, training, and process improvements. The preferred schedule is Monday through Friday, 8:30 a.m. to 5:00 p.m. Mountain Standard Time. Specialty Pharmacy experience is required. Soleo Health is a national provider of complex specialty pharmacy and infusion services administered in the home or at alternate sites of care. The company describes its core values as improving patients’ lives, being passionate, encouraging creative thinking, making decisions with an ownership mindset, doing the right thing, and having fun. Soleo Health states that it is committed to diversity, equity, and inclusion and is an Equal Opportunity Employer.

Requirements

Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy from an accredited institution.
Active, unrestricted U.S. pharmacist license.
At least 2 years of experience in prior authorization, utilization management, PBM, managed care, or payer pharmacy operations.
Specialty Pharmacy experience.
Strong understanding of drug therapy, clinical guidelines, specialty medications, and formulary management.
Excellent analytical, clinical decision-making, and documentation skills.
Proficiency with pharmacy benefit systems, prior authorization platforms, and electronic documentation.
Strong written and verbal communication skills.
Ability to manage multiple priorities and work in a fast-paced environment with strict timelines.
High integrity and ability to handle confidential or sensitive clinical information.
Ability to communicate effectively with all levels of the organization.
Enthusiastic support for Soleo Health’s philosophy and goals.

Nice To Haves

Multi-state pharmacist licensure.
Experience reviewing specialty medications, biologics, or complex therapy classes.
Prior PBM or health plan experience.
Experience with clinical criteria development, formulary management, or utilization management programs.
Familiarity with claims systems, prior authorization automation tools, or pharmacy informatics.
Competence using Word, Excel, and PowerPoint.

Responsibilities

Conduct comprehensive clinical reviews of specialty pharmacy and infusion therapy prior authorization requests to ensure appropriateness, accuracy, and completeness.
Evaluate 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 to support timely determinations.
Communicate with PBMs and health plans to clarify clinical information, respond to requests for documentation, and resolve authorization issues.
Mitigate denials by addressing rejections in real time through outreach to PBMs and payers.
Prepare and submit evidence-based appeal letters, including clinical rationale, literature support, and policy alignment, as needed.
Collaborate with the patient access team and other internal stakeholders to obtain documentation and optimize patient access to therapy.
Monitor authorization outcomes and performance metrics to identify delays, barriers, or trends affecting patient access.
Stay current with payer policies, clinical guidelines, and regulatory requirements affecting specialty pharmacy and infusion services.
Identify workflow and training opportunities and contribute to process improvements that support efficiency, compliance, and patient access.