Appeals Pharmacist (Remote)

Pharmacy Careers; Emmendingen (Kernstadt); Hybrid; EUR 60.000 - 80.000; Vollzeit

Zusammenfassung

A leading managed care organization in Baden-Württemberg is looking for an experienced Appeals Pharmacist to review medication coverage appeals. This position plays a critical role in advocating for patients and ensuring fair access to necessary medications. Ideal candidates will hold a Doctor of Pharmacy degree and possess strong clinical skills. Competitive salary and benefits are offered, with opportunities for growth in managed care pharmacy.

Leistungen

Competitive salary

Comprehensive benefits

Opportunities for advancement

Qualifikationen

• Active and unrestricted pharmacist license in the U.S.
• Prior managed care or utilization management experience preferred.
• Retail and hospital pharmacists with strong clinical and documentation skills encouraged.

Aufgaben

• Review clinical documentation for medication coverage appeals.
• Prepare written clinical rationales to support appeal determinations.
• Track, document, and report appeal outcomes in compliance with regulations.

Kenntnisse

Excellent clinical judgment

Written communication

Attention to regulatory detail

Ausbildung

Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy degree

Jobbeschreibung

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

• Education: Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy degree.
• Licensure: Active and unrestricted pharmacist license in the U.S.
• Experience: Prior managed care or utilization management experience preferred — retail and hospital pharmacists with strong clinical and documentation skills are encouraged to apply.
• Skills: Excellent clinical judgment, written communication, and attention to regulatory detail.

Why This Role?

• Impact: Play a critical role in ensuring patients get fair access to necessary medications.
• Growth: Gain expertise in appeals, utilization management, and managed care pharmacy.
• Flexibility: Many roles offer hybrid or fully remote options.
• Rewards: Competitive salary, comprehensive benefits, and opportunities for advancement.

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.