Pharmacy Appeals Specialist - Clinical Impact & PBM

MedImpact Healthcare Systems, Inc.; Oregon; Hybrid; USD 72,000 - 129,000; Full time

Benefits offered by this job

Medical / Dental / Vision / Wellness

401K with Company match

Paid Time Off / Holidays

Tuition Reimbursement

Employee Referral Bonus

Job summary

MedImpact Healthcare Systems, Inc. is seeking an Appeals Clinical Specialist to independently conduct clinical reviews of medical records for appeal cases.

You will ensure accuracy, timeliness, and regulatory compliance while evaluating drug therapy and benefit coverage for members and providers. The role emphasizes cost-effectiveness and collaboration with cross-functional teams to maintain quality in the appeals process.

Qualifications

• PharmD degree with licensure to practice in the United States.
• Experience in clinical reviews or formulary management preferred.
• Strong knowledge of regulatory and accreditation standards.

Responsibilities

• Provide appeal clinical support services including review, analysis, and documentation of appeals.
• Review medication request guidelines for clinical appropriateness and efficiency.
• Provide drug information support and prepare related meeting materials.
• Coordinate utilization and compliance reporting for client plans.
• Support project work for appeal program development and communications.
• Offer feedback to Prior Authorization and Appeals teams.

Skills

Pharmacist licensed

Clinical review

Regulatory knowledge

Communication

Education

PharmD

Tools

Microsoft Office

Job description

MedImpact Healthcare Systems, Inc. is seeking an Appeals Clinical Specialist to independently conduct clinical reviews of medical records for appeal cases.

You will ensure accuracy, timeliness, and regulatory compliance while evaluating drug therapy and benefit coverage for members and providers. The role emphasizes cost-effectiveness and collaboration with cross-functional teams to maintain quality in the appeals process.