Remote Appeals Pharmacist — Fair Access Advocate

Pharmacy Careers; Huntsville (AL); Hybrid; USD 120,000 - 150,000; Full time

Benefits offered by this job

Competitive salary

Comprehensive benefits

Advancement paths

Job summary

Pharmacy Careers seeks a remote Appeals Pharmacist to review medication coverage requests, apply evidence-based guidelines, and issue clear written rationales from home. The role emphasizes fair access for members and collaboration with health plans and medical directors.

Ideal candidates hold a PharmD or Bachelor of Pharmacy, with managed care or utilization management experience and strong regulatory and documentation skills.

Qualifications

• PharmD or Bachelor of Pharmacy required.
• Experience in managed care or utilization management preferred.
• Strong 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 seeks a remote Appeals Pharmacist to review medication coverage requests, apply evidence-based guidelines, and issue clear written rationales from home. The role emphasizes fair access for members and collaboration with health plans and medical directors.

Ideal candidates hold a PharmD or Bachelor of Pharmacy, with managed care or utilization management experience and strong regulatory and documentation skills.