Remote Appeals Pharmacist: Fair Medication Access

Pharmacy Careers; Kansas City (MO); Remote; USD 110,000 - 140,000; Full time

Benefits offered by this job

Comprehensive benefits

Remote or hybrid options

Advancement opportunities

Job summary

Pharmacy Careers is seeking a Remote Appeals Pharmacist to review medication coverage appeals from home, applying evidence-based guidelines and regulatory requirements to reach fair determinations. This role emphasizes strong clinical writing and collaboration with physicians and medical directors.

We offer fully remote or hybrid options, a competitive salary, comprehensive benefits, and growth opportunities in managed care and appeals.

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 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 review medication coverage appeals from home, applying evidence-based guidelines and regulatory requirements to reach fair determinations. This role emphasizes strong clinical writing and collaboration with physicians and medical directors.

We offer fully remote or hybrid options, a competitive salary, comprehensive benefits, and growth opportunities in managed care and appeals.