Prior Authorization Pharmacist Advisor (Contract)
About the role We are seeking an experienced Prior Authorization Pharmacist to serve as an advisor and mentor to a mid-career pharmacist reviewer. This role is focused on improving case review productivity, workflow efficiency, and documentation quality across prior authorization and related pharmacy benefit review activities. The ideal candidate brings deep experience in pharmacy benefit review and can help increase sustainable review throughput by up to 3 additional cases per hour, while maintaining strong clinical judgment, compliance, and defensible decision-making. Key responsibilities • Mentor and coach a mid-career pharmacist reviewer in prior authorization workflow optimization • Evaluate current review processes and identify opportunities to improve speed, accuracy, and consistency • Advise on best practices for reviewing pharmacy benefit cases, including prior authorizations, coverage determinations, and appeals • Improve efficiency in case triage, clinical evaluation, documentation, and decision routing • Develop practical workflow tools, templates, and review frameworks to reduce avoidable delays and rework • Support measurable gains in productivity without compromising quality, compliance, or audit readiness • Help establish performance benchmarks, quality safeguards, and sustainable improvement plans • Share real-world operational strategies that strengthen reviewer confidence and throughput Ideal candidate • PharmD required • Active pharmacist license required • 5+ years of experience in prior authorization, utilization management, managed care pharmacy, or pharmacy benefit review • Strong background in clinical case review, pharmacy benefit interpretation, and documentation • Experience mentoring, coaching, or developing pharmacists or clinical reviewers • Ability to identify workflow bottlenecks and recommend clear, practical improvements • Strong understanding of quality, compliance, and defensible review practices in pharmacy operations Preferred qualifications • Experience in health plan, PBM, or managed care pharmacy environments • Experience with prior authorization, appeals, coverage determinations, and formulary exception workflows • Exposure to productivity improvement, QA, audit support, or reviewer calibration initiatives • Strong communication skills with the ability to mentor in a constructive, performance-oriented manner What success looks like • A clear assessment of current reviewer workflow and performance opportunities • Improved review efficiency and more consistent case handling • Sustainable productivity improvement targeting up to 3 additional cases per hour, depending on case mix and workflow constraints • Stronger documentation quality and decision consistency • A practical playbook for continued reviewer growth and operational performance Engagement structure • Remote • Flexible, part-time advisory engagement • Project-based or hourly consulting arrangement • Ideal for a senior managed care pharmacist who enjoys mentoring and operational improvement How to apply Please send: • A brief summary of your prior authorization or managed care pharmacy experience • Examples of reviewer mentoring, coaching, or workflow improvement work • Relevant environments supported, such as prior authorization, appeals, or coverage determination • Your availability and rate