Appeals Pharmacist (Remote)

Appeals Pharmacist - Ensure Fair Medication Access for Patients

A confidential managed care organization is seeking an experienced Appeals Pharmacist to review, evaluate, and process medication coverage appeals. This role is ideal for pharmacists who want to leverage their clinical knowledge and critical thinking skills to advocate for patients and ensure fair, evidence-based decisions.

Key Responsibilities

• Review clinical documentation for medication coverage appeals and grievances.
• Apply evidence-based guidelines, plan policies, and regulatory requirements to determine outcomes.
• Prepare written clinical rationales to support appeal determinations.
• Collaborate with physicians, nurses, and medical directors during case reviews.
• Track, document, and report appeal outcomes in compliance with state and federal regulations.
• Support process improvements to enhance timeliness and quality of appeal decisions.

What You'll Bring

Why This Role?

About Us

We are a confidential healthcare partner working with health plans and managed care organizations nationwide. Our appeals pharmacists safeguard patient access while ensuring compliance with all regulatory standards.

Apply Today

Join our team as an Appeals Pharmacist and help ensure every patient receives a fair review of their medication needs.