Remote Appeals Pharmacist - Fair Drug Access & Policy Expert

Pharmacy Careers; Bridgeport (CT); Remote; USD 120,000 - 160,000; Full time

Benefits offered by this job

Fully remote work

Comprehensive benefits

Advancement opportunities

Job summary

Pharmacy Careers is seeking a highly qualified Remote Appeals Pharmacist to support fair access to medications and advocate for members' needs. You will review clinical data, apply guidelines, and craft written rationales for appeal outcomes.

The role supports flexible schedules, remote work or hybrid options, and opportunities to collaborate with physicians, nurses, and medical directors while upholding regulatory standards.

Qualifications

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

Responsibilities

• Review clinical documentation for medication coverage appeals.
• 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

Excellent clinical judgment

Written communication

Regulatory attention to detail

Managed care / utilization management

Education

PharmD

Bachelor of Pharmacy

Job description

Pharmacy Careers is seeking a highly qualified Remote Appeals Pharmacist to support fair access to medications and advocate for members' needs. You will review clinical data, apply guidelines, and craft written rationales for appeal outcomes.

The role supports flexible schedules, remote work or hybrid options, and opportunities to collaborate with physicians, nurses, and medical directors while upholding regulatory standards.