PharmD – Appeals Clinical Specialist

MedImpact Healthcare Systems, Inc.; United States; Remote; USD 72,000 - 129,000; Full time

Benefits offered by this job

Medical / Dental / Vision / Wellness

Paid Time Off / Holidays

Incentive Compensation

401K with Company match

Life and Disability Insurance

Tuition Reimbursement

Employee Referral Bonus

Job summary

MedImpact Healthcare Systems, Inc. seeks an Appeal Clinical Specialist to join the Appeals team. You will conduct clinical reviews of medical records, apply guidelines, and determine benefit coverage, ensuring timely, accurate, and compliant outcomes.

The role requires a PharmD with 3+ years’ experience and a current US Pharmacist license. It’s a full‑time, non‑exempt position based on-site at the San Diego HQ, with potential remote options, and involves cross‑functional collaboration to support

Qualifications

• PharmD with 3+ years’ experience; current US Pharmacist license.
• Experience conducting clinical reviews and applying guidelines.
• Familiarity with regulatory/accreditation standards.

Responsibilities

• Conduct appeal clinical reviews of medical records and determine benefit coverage.
• Apply clinical criteria and guidelines to decisions.
• Ensure reviews are accurate, timely, and compliant with regulations.

Skills

Clinical review

Regulatory compliance

Microsoft Office / Outlook

Research & literature review

Analytical thinking

Education

PharmD

Tools

Microsoft Office

Microsoft Outlook

Databases

Internet searches

Job description

MedImpact Healthcare Systems, Inc. seeks an Appeal Clinical Specialist to join the Appeals team. You will conduct clinical reviews of medical records, apply guidelines, and determine benefit coverage, ensuring timely, accurate, and compliant outcomes.

The role requires a PharmD with 3+ years’ experience and a current US Pharmacist license. It’s a full‑time, non‑exempt position based on-site at the San Diego HQ, with potential remote options, and involves cross‑functional collaboration to support