Remote Appeals Pharmacist — Ensuring Fair Medication Access

Pharmacy Careers; Missoula (MT); Remote; USD 120,000 - 150,000; Full time

Benefits offered by this job

Competitive salary

Comprehensive benefits

Advancement paths

Job summary

Pharmacy Careers is seeking a Remote Appeals Pharmacist to combine clinical expertise with advocacy, reviewing medication coverage appeals and applying evidence-based guidelines to ensure fair determinations from home with a schedule that supports work-life balance.

Ideal candidates hold a PharmD or Bachelor of Pharmacy and have managed care or utilization management experience. Strong clinical judgment and regulatory attention to detail are essential.

Qualifications

• PharmD or Bachelor of Pharmacy
• Managed care or utilization management preferred
• Excellent clinical judgment, written communication, and regulatory attention to detail

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

Written communication

Regulatory attention to detail

Education

PharmD or Bachelor of Pharmacy

Job description

Pharmacy Careers is seeking a Remote Appeals Pharmacist to combine clinical expertise with advocacy, reviewing medication coverage appeals and applying evidence-based guidelines to ensure fair determinations from home with a schedule that supports work-life balance.

Ideal candidates hold a PharmD or Bachelor of Pharmacy and have managed care or utilization management experience. Strong clinical judgment and regulatory attention to detail are essential.