Appeals Pharmacist (Remote)

Pharmacy Careers; Fargo (ND); Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

Remote work

Career progression

Job summary

Pharmacy Careers seeks a fully remote Appeals Pharmacist to ensure fair access to medications. Review appeals, apply evidence-based guidelines, and craft clear clinical rationales from home, supporting patient care and regulatory compliance.

Collaborate with physicians and care teams, document determinations in detail, and contribute to utilization management improvements. Requires PharmD or Bachelor of Pharmacy; managed care or hospital experience is preferred, with strong clinical writing.

Qualifications

• PharmD or Bachelor of Pharmacy required.
• Managed care or hospital experience preferred; strong documentation and clinical skills highly valued.
• Proven ability to write clear, evidence-based clinical rationales and summaries.

Responsibilities

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

Skills

Clinical judgment

Written communication

Regulatory compliance

Collaboration

Evidence-based writing

Education

PharmD

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.