Remote Appeals Pharmacist — Championing Fair Medication Access

Pharmacy Careers; Cedar Rapids (IA); Remote; USD 90,000 - 130,000; Full time

Job summary

Pharmacy Careers is seeking a Remote Appeals Pharmacist to join a confidential partner program focused on fair medication access. In this fully remote role, you will review medication coverage appeals, apply evidence-based guidelines, and craft clear rationales to support decisions for members.

You will collaborate with physicians, nurses, and medical directors during case reviews, ensure compliance with state and federal rules, and contribute to process improvements.

Qualifications

• PharmD or Bachelor of Pharmacy required.
• Managed care or utilization management experience preferred.
• Strong documentation and clinical skills required.

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.

Skills

Clinical judgment

Regulatory attention to detail

Written communication

Education

PharmD or Bachelor of Pharmacy

Job description

Pharmacy Careers is seeking a Remote Appeals Pharmacist to join a confidential partner program focused on fair medication access. In this fully remote role, you will review medication coverage appeals, apply evidence-based guidelines, and craft clear rationales to support decisions for members.

You will collaborate with physicians, nurses, and medical directors during case reviews, ensure compliance with state and federal rules, and contribute to process improvements.