About the Opportunity
US Tech Solutions, a leading global staff‑augmentation firm, partners with top‑tier healthcare payors and providers to deliver innovative, high‑impact solutions across the United States and beyond. Our mission is to empower skilled professionals to make a measurable difference in patients’ lives while advancing their own careers in a dynamic, technology‑enabled environment. We are currently seeking an experienced, highly motivated Remote Specialty Pharmacy Operations Advisor to join our expanding team of Clinical Pharmacists who specialize in prior‑authorization (PA) review for high‑cost specialty medications.
Why This Role Stands Out
In today’s rapidly evolving therapeutic landscape, specialty drugs—often life‑saving but exceedingly expensive—require rigorous, evidence‑based prior‑authorization processes to ensure appropriate use, safety, and cost‑effectiveness. As a Clinical Pharmacist Advisor, you will be at the forefront of these critical decisions, applying your clinical expertise to evaluate complex cases, communicate outcomes to providers and patients, and uphold the highest standards of regulatory compliance. This is a fully remote, contract position (minimum 6 months, with potential extension) offering immediate start, competitive compensation, and the chance to work with cutting‑edge health‑technology platforms such as Novologix.
Key Responsibilities
As a Remote Specialty Pharmacy Operations Advisor, you will be expected to:
- Clinical Review & Decision‑Making (20%): Conduct thorough, evidence‑based clinical assessments of specialty medication requests, applying payer‑specific criteria and evidence‑based guidelines to determine approval, denial, or need for additional information.
- Collaboration & Data Collection (20%): Partner closely with pharmacy technicians, registered nurses, and other care‑team members to gather necessary clinical documentation, clarify therapeutic intent, and ensure all submissions meet health‑plan and employer service‑level agreements (SLAs).
- Stakeholder Communication (15%): Draft concise, professional communication of authorization decisions to physicians, health‑plan representatives, patients, and other healthcare professionals, adhering to approved denial management processes and ensuring timely follow‑up.
- Inbound Call Management (50%): Serve as the primary point of contact for inbound inquiries from prescribers, patients, and payor representatives regarding pending, approved, or denied prior authorizations, providing clear guidance, troubleshooting issues, and escalating complex cases as needed.
- Relationship Building (5%): Maintain and strengthen ongoing communication channels among our organization, partner health plans, and employer groups, fostering trust and ensuring seamless workflow integration.
- Continuous Learning (5%): Stay abreast of emerging drug therapies, disease state management, and evolving payer policies relevant to specialty medication programs administered via the Novologix platform.
- Additional Projects & On‑Call Support (5%): Contribute to special initiatives, quality‑improvement projects, and provide after‑hours or on‑call pharmacist availability in alignment with operational needs.
Essential Qualifications
To succeed in this role, candidates must demonstrate the following core competencies:
- Licensure: Active, unrestricted pharmacist license (RPh) in the state of residence, held in good standing.
- Education: Doctor of Pharmacy (Pharm.D.) degree from an accredited institution.
- Clinical Experience: Minimum of two years of experience as a pharmacist within a managed‑care, health‑plan, or specialty pharmacy environment, with a strong emphasis on prior‑authorization processes.
- Prior‑Authorization Expertise: Proven track record of reviewing, adjudicating, and communicating specialty medication prior‑authorization cases, including handling appeals and escalations.
- Technology Proficiency: Comfortable navigating Windows‑based applications, MS Office Suite, and electronic prior‑authorization platforms (e.g., Novologix, CoverMyMeds).
- Communication Skills: Exceptional verbal and written communication abilities, with a talent for translating complex clinical information into clear, actionable messages for diverse audiences.
- Organizational Acumen: Strong attention to detail, ability to prioritize high‑volume caseloads, and consistent adherence to SLAs and compliance standards.
Preferred Qualifications & Desirable Experience
- Experience in retail or acute‑care hospital pharmacy settings, providing a well‑rounded perspective on medication workflows.
- Familiarity with specialty drug classes such as oncology, immunology, rare disease therapies, and advanced biologics.
- Exposure to electronic health records (EHR) and health‑information exchange standards (e.g., HL7, FHIR).
- Certification in a relevant specialty (e.g., Board Certified Ambulatory Care Pharmacist – BCACP, Certified Specialty Pharmacist – CSP).
- Demonstrated ability to lead or contribute to process‑improvement initiatives, such as reducing turnaround time for PA decisions.
Core Skills & Competencies for Success
- Analytical Thinking: Ability to synthesize clinical data, lab results, and patient histories to make sound, evidence‑based authorization decisions.
- Problem Solving: Proactive in identifying gaps in documentation, addressing prescriber concerns, and navigating complex payer policies.
- Interpersonal Skills: Empathetic yet professional when handling high‑stress calls from physicians or patients, fostering collaborative relationships.
- Regulatory Knowledge: Up‑to‑date understanding of FDA, CMS, and state pharmacy regulations affecting specialty drug utilization.
- Time Management: Efficient multitasking across review, communication, and documentation tasks while meeting strict deadline requirements.
- Technology Agility: Quick adaptation to new software tools, platforms, and telehealth solutions that enhance PA workflow.
Career Growth & Professional Development
US Tech Solutions is invested in the long‑term success of its talent. As a Remote Specialty Pharmacy Operations Advisor, you will have access to a suite of development resources, including:
- Continuing Education Stipends: Funding for accredited pharmacy CE courses, specialty certifications, and industry conferences.
- Mentorship Programs: Pairing with senior clinical pharmacists and operations leaders to deepen expertise and broaden leadership capabilities.
- Pathways to Advancement: Opportunities to transition into senior advisory roles, clinical program management, or strategic consulting positions within US Tech Solutions or partner health plans.
- Cross‑Functional Exposure: Collaboration with data‑analytics, IT, and quality‑improvement teams, providing a holistic view of the health‑care ecosystem.
Work Environment & Culture
At US Tech Solutions, we champion a culture of innovation, inclusion, and flexibility. Even though this role is fully remote, you will be an integral part of a vibrant, collaborative community that values:
- Work‑Life Balance: Flexible scheduling, generous paid time off, and a supportive environment that respects personal commitments.
- Diversity & Inclusion: A commitment to equal opportunity, fostering a workplace where diverse perspectives thrive and every voice is heard.
- Technology‑First Mindset: Utilizing secure, cloud‑based platforms to ensure seamless communication and data integrity across geographic boundaries.
- Team Spirit: Regular virtual huddles, knowledge‑sharing sessions, and recognition programs that celebrate achievements and milestones.
Compensation, Perks & Benefits (General Overview)
US Tech Solutions offers a competitive compensation package designed to attract top talent. While exact figures are tailored to experience and market benchmarks, the overall package typically includes:
- Base Salary: Market‑aligned salary with performance‑based incentives.
- Health & Wellness: Comprehensive medical, dental, and vision coverage, along with wellness programs and mental‑health resources.
- Retirement Savings: 401(k) plan with employer matching contributions.
- Paid Time Off: Generous PTO accrual, paid holidays, and sick leave.
- Technology Stipend: Reimbursement for home‑office equipment, high‑speed internet, and secure VPN access.
- Professional Development: CE allowances, certification support, and tuition reimbursement for relevant coursework.
Application Process & Next Steps
If you are ready to make a tangible impact on specialty medication access while advancing your pharmacy career in a forward‑thinking, remote environment, we invite you to apply today. To streamline the review, please be prepared to answer the following brief questionnaire:
- How many years of prior‑authorization experience do you have?
- Approximately how many prior‑auth cases have you managed in your most recent role?
- Do you have experience handling direct calls from prescribers and patients regarding prior‑authorization outcomes and appeals?
Submit your updated resume, a concise cover letter outlining your relevant experience, and your responses to the questionnaire through the link below. Our recruitment team will evaluate your application promptly and reach out to schedule a virtual interview.
We Want to Hear From You!
If this role resonates with your expertise and career aspirations, don’t hesitate—apply now and become a vital part of a team that is reshaping the future of specialty pharmacy care.
Equal Opportunity Employer
US Tech Solutions is proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.
Apply Now