Remote Appeals Pharmacist: Fair Access & Evidence-Based

Pharmacy Careers; Newark (NJ); Remote; USD 110,000 - 160,000; Full time

Benefits offered by this job

Fully remote

Hybrid options available

Job summary

Pharmacy Careers is seeking a Remote Appeals Pharmacist focused on fair medication access. This fully remote or hybrid role involves reviewing medication coverage appeals, applying evidence-based guidelines, and writing clear clinical rationales for determinations.

You will collaborate with physicians and medical directors, ensure regulatory compliance, and help advance appeals and utilization management while balancing work-life demands.

Qualifications

• PharmD or Bachelor of Pharmacy required.
• Experience in managed care or utilization management preferred.
• Strong documentation and clinical skills encouraged.

Responsibilities

• Review clinical documentation for medication coverage appeals.
• Apply plan policies, guidelines, and regulatory requirements to reach determinations.
• Prepare written clinical rationales supporting outcomes.
• Collaborate with physicians, nurses, and medical directors during case reviews.
• Track and report appeal outcomes in compliance with state and federal rules.
• Contribute to process improvements that enhance timeliness and quality.

Skills

Excellent clinical judgment

Written communication

Regulatory attention to detail

Education

PharmD or Bachelor of Pharmacy

Job description

Pharmacy Careers is seeking a Remote Appeals Pharmacist focused on fair medication access. This fully remote or hybrid role involves reviewing medication coverage appeals, applying evidence-based guidelines, and writing clear clinical rationales for determinations.

You will collaborate with physicians and medical directors, ensure regulatory compliance, and help advance appeals and utilization management while balancing work-life demands.