Appeals Pharmacist (Remote)

Pharmacy Careers; Rapid City (SD); Remote; USD 110,000 - 160,000; Full time

Job summary

Pharmacy Careers seeks a fully remote Appeals Pharmacist to review medication coverage appeals, apply evidence-based guidelines, and ensure fair determinations for members from home with a work-life balance-friendly schedule.

Responsibilities include reviewing clinical documentation, applying plan policies, and preparing rationales while collaborating with clinicians on case reviews. The role offers remote or hybrid options, competitive compensation, benefits, and career advancement.

Qualifications

• PharmD or Bachelor of Pharmacy required.
• Experience in managed care, utilization management, or hospital/ambulatory/pharmacy settings with strong documentation.

Responsibilities

• Review medication coverage appeals and clinical documentation.
• Apply plan policies and evidence-based guidelines to determinations.
• Prepare clear written rationales for 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 attention to detail

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.