Remote Managed Care Pharmacist Job Description

Join Us as a Remote Managed Care Pharmacist

Are you a licensed pharmacist with a strategic approach and commitment to enhancing healthcare results on a large scale? Ready to help shape the future of healthcare from the comfort of your home? This is your chance to make a real difference. As a Remote Managed Care Pharmacist, you will play a crucial role in guiding medication therapy decisions, optimizing formulary strategies, and ensuring that patients can access high-quality, financially sustainable treatments. Make an impact—take charge of your future today.

About the Role

In this high-impact position, you’ll collaborate across departments to drive excellence in formulary management, utilization review, and pharmaceutical cost containment. You'll work closely with healthcare providers, analysts, and administrators to evaluate drug efficacy, monitor treatment outcomes, and ensure compliance with evolving regulatory guidelines. This is more than just a remote job—it’s an opportunity to contribute to a healthcare system that truly values transparency, quality, and accessibility.

Key Responsibilities

Clinical and Formulary Management

• Review and evaluate prior authorization requests for medical necessity, safety, and cost-effectiveness.
• Support formulary development by analyzing clinical evidence and cost-effectiveness studies.
• Collaborate with medical directors and clinical teams to implement evidence-based guidelines.
• Assist in determining tier placement for new medications within the health plan formulary.

Data-Driven Strategy

• Leverage claims data, utilization reports, and prescribing trends to drive recommendations.
• Monitor therapeutic outcomes and identify opportunities for intervention
• Contribute meaningfully to the planning and rollout of impactful improvement initiatives

Provider and Patient Engagement

• Provide clinical guidance to providers through telephonic consultations and written communications.
• Educate healthcare professionals on formulary updates and utilization criteria.
• Assist patients by clarifying medication coverage and recommending alternative therapies when appropriate.

Regulatory and Compliance Alignment

• Ensure adherence to Medicare Part D, Medicaid, and commercial payer regulations.
• Prepare documentation for audits, appeals, and pharmacy & therapeutics (P&T) committee meetings.
• Stay informed about regulatory changes that impact managed care pharmacy practice.

What You’ll Need to Succeed

Educational Background

• Doctor of Pharmacy (PharmD) or equivalent degree from an accredited school of pharmacy
• Active pharmacist license in good standing in any U.S. state

Professional Experience

• Minimum of 2–3 years in managed care, clinical pharmacy, or pharmacy benefit management
• Familiarity with prior authorization systems, formulary strategy, and drug utilization review
• Firm grasp of therapeutic guidelines across multiple disease states, especially chronic and high-cost conditions

Skills and Competencies

• Strong problem-solving capabilities and proficiency in understanding detailed clinical data
• Strong verbal and written communication for engaging both clinical and non-clinical stakeholders
• Adept at using drug databases, EMRs, and pharmacy software systems
• Comfortable working independently and managing a remote workflow efficiently

Tools and Technology You’ll Use

• Pharmacy benefit management platforms and prior authorization portals
• Electronic Health Records (EHR) systems and claims adjudication software
• Microsoft Office Suite (Excel, Word, Outlook) for documentation and reporting
• Secure communication tools for team collaboration and provider outreach

Your Work Environment

This is a fully remote position designed for performance, flexibility, and balance. You’ll operate within a tech-enabled home office environment, supported by virtual training, digital documentation systems, and an interconnected team of healthcare professionals. With minimal supervision, you’ll manage your daily workflow while participating in virtual team huddles and collaborative review sessions.

Why You'll Love Working Here

Inspiring Mission, Tangible Impact

You won’t just be managing medications—you’ll be actively shaping smarter, safer treatment plans that make healthcare more equitable and effective.

Dynamic and Purpose-Driven Culture

Our team thrives on shared values: collaboration, accountability, and compassion. We’re driven by results but grounded in empathy.

Exciting Perks and Benefits

• 💻 100% remote work—set up your workspace your way
• 💰 Annual salary of $130,400
• 📚 Continuing education support and clinical development programs
• 🏖 Generous PTO and flexible scheduling
• 🩺 Comprehensive health, dental, and vision insurance
• 📈 401(k) with company match and retirement planning resources

Opportunities for Growth

We’re expanding our managed care initiatives nationwide. That means you’ll have the chance to:

• Take the lead on clinical initiatives
• Mentor incoming pharmacists and shape best practices
• Influence P&T committee decisions through your insights
• Access leadership development opportunities as the organization scales

Your Path to Making a Difference

We’re searching for individuals who don’t just want a job—they want to leave a legacy. This is the ideal role for pharmacists who excel at the intersection of healthcare and policy, who view data as a powerful storytelling tool, and who are eager to be the voice of patients in the managed care space.

Whether you’re refining coverage criteria, recommending therapeutic alternatives, or steering clinical programs, your contributions will be felt by thousands of lives every day.

Take the First Step

Your next big opportunity awaits—apply now and bring your expertise to a team that’s reimagining healthcare, one prescription at a time.