Remote Adherence Pharmacist - Prior Authorization & Appeals

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

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.