REMOTE Adherence Pharmacist

Insight Global; Minnetonka (MN); Remote; USD 110,000 - 140,000; Full time

Job summary

Insight Global is seeking a Pharmacist for Prior Authorization (PA) & Appeals to review requests and determine coverage based on clinical guidelines, policies, and plan benefits. This role collaborates with physicians, providers, and internal teams to gather information and make evidence-based decisions in a fast-paced environment.

The pharmacist will ensure compliance with Medicare Part D, Medicaid, and commercial regulations, document decisions accurately, and support process improvements.

Qualifications

• Pharmacist degree (Bachelors or PharmD) and active license.
• Current licensed pharmacist within the state of work.
• 6+ months of customer service with healthcare professionals.
• Proficiency with Excel, Word, and Outlook.
• Comfortable with a fast-paced, call-center style environment.

Responsibilities

• Review and evaluate prior authorization requests to determine coverage.
• Evaluate appeals requests based on guidelines and benefits.
• Collaborate with physicians, providers, and internal teams to gather clinical information.
• Document case decisions accurately following internal protocols.
• Maintain compliance with state and federal pharmacy laws and regulations.

Skills

Customer service for healthcare pros

MS Excel

MS Word

MS Outlook

Remote work adaptability

Education

Bachelor's or PharmD

Active State Pharmacist License

Current licensed pharmacist in work state

Job description

Job Description

The Pharmacist, Prior Authorization (PA) & Appeals, is responsible for reviewing and evaluating prior authorization and appeals requests to determine coverage based on clinical guidelines, pharmacy policies, and health plan benefits. In this fast-paced, high-volume environment, the pharmacist works closely with physicians, healthcare providers, pharmacy technicians, and internal teams to gather and assess clinical information, make evidence-based coverage determinations, recommend formulary-compliant and cost-effective treatment alternatives, and ensure compliance with federal and state regulations. The role requires strong clinical judgment, attention to detail, effective communication skills, and the ability to manage competing priorities while meeting productivity and quality standards. Additionally, the pharmacist supports quality assurance initiatives, resolves provider and pharmacy inquiries, participates in process improvement efforts, and contributes to a collaborative, customer-focused team environment. Maintain full compliance with state and federal pharmacy laws, Medicare Part D, Medicaid, and commercial benefit regulations. Accurately document case decisions in accordance with internal protocols, auditing standards, and confidentiality policies. Effectively manage case volume by organizing workload, setting daily priorities, and meeting productivity and quality benchmarks. Adapt to fluctuating demands while maintaining accuracy and professionalism under pressure.

Skills and Requirements

• Bachelors or Doctorate of Pharmacy; Active State Pharmacist License
• Current Licensed Pharmacist within the state of work
• 6+ months of customer service/customer relations with healthcare professionals
• Technology savvy - Basic proficiency with Microsoft Excel (ability to create, edit, and save a basic spreadsheet), Microsoft Word (ability to create, edit, and save a basic document) and basic proficiency with Microsoft Outlook (ability to send emails)
• Comfortable with call center / production-based environment
• Ability to perform responsibilities and duties remotely with little to no supervision
• Comfortable in a fast-paced, high-volume workload
• Ability to be adaptable, team-oriented culture requiring flexibility and adaptability to changing business needs.

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal employment opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment without regard to race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or the recruiting process, please send a request to [e-mail].