Appeals Pharmacist (Remote)

Pharmacy Careers; Albuquerque (NM); Remote; USD 120,000 - 150,000; Full time

Benefits offered by this job

Flexible work options

Comprehensive benefits

Job summary

Pharmacy Careers is seeking a fully remote Appeals Pharmacist to review medication coverage appeals, apply evidence-based guidelines, and ensure fair determinations for members from home. The role offers a schedule that supports work-life balance.

You’ll collaborate with physicians and medical directors, document clinical rationales, and report outcomes in compliance with applicable regulations. A PharmD or equivalent is required, with preference for managed care or utilization management

Qualifications

• Education: PharmD or Bachelor of Pharmacy.
• Experience: Managed care or utilization management preferred; hospital, ambulatory and community pharmacists encouraged to apply.
• Skills: Excellent clinical judgment, written communication, and regulatory attention to detail.

Responsibilities

• Review clinical documentation for medication coverage appeals and grievances.
• Apply plan policies, evidence-based guidelines, and regulatory requirements to reach determinations.
• Prepare clear written clinical rationales supporting appeal outcomes.
• Collaborate with physicians, nurses, and medical directors during case reviews.
• Track and report appeal outcomes in full compliance with state and federal rules.
• Contribute to process improvements that enhance timeliness and quality.

Skills

Clinical judgment

Written communication

Regulatory attention to detail

Education

PharmD or Bachelor of Pharmacy

Job description

Remote Appeals Pharmacist – Fair Medication Access | Work From Home | Strong Clinical Writing Focus

Combine clinical expertise with advocacy in a fully remote Appeals Pharmacist role. Review medication coverage appeals, apply evidence-based guidelines, and ensure fair determinations for members — all from home with a schedule that supports better work-life balance.

Key Responsibilities

• Review clinical documentation for medication coverage appeals and grievances.
• Apply plan policies, evidence-based guidelines, and regulatory requirements to reach determinations.
• Prepare clear written clinical rationales supporting appeal outcomes.
• Collaborate with physicians, nurses, and medical directors during case reviews.
• Track and report appeal outcomes in full compliance with state and federal rules.
• Contribute to process improvements that enhance timeliness and quality.

What You’ll Bring

• Education: PharmD or Bachelor of Pharmacy.
• Experience: Managed care or utilization management preferred. Hospital, ambulatory, and community pharmacists with strong documentation and clinical skills are encouraged to apply.
• Skills: Excellent clinical judgment, written communication, and regulatory attention to detail.

Why This Role?

• Fully remote or hybrid options available.
• Play a critical role in ensuring patients receive fair access to necessary medications.
• Build expertise in appeals, utilization management, and managed care.
• Competitive salary, comprehensive benefits, and advancement paths.

About Us

We are a confidential healthcare partner working with health plans and managed-care organizations nationwide. Our appeals pharmacists protect patient access while upholding regulatory standards.