Remote Appeals Pharmacist — Fair Medication Access

Pharmacy Careers; Wilmington (DE); Remote; USD 110,000 - 150,000; Full time

Benefits offered by this job

Remote or hybrid work options

Competitive salary

Comprehensive benefits

Advancement paths

Job summary

Pharmacy Careers seeks a Remote Appeals Pharmacist to review medication coverage appeals from home or hybrid settings. You will apply evidence-based guidelines, draft clinical rationales, and collaborate with clinicians to ensure fair access for members.

This fully remote role emphasizes strong documentation, regulatory attention, and a commitment to managed care principles. A PharmD or equivalent, and experience in managed care are preferred, with competitive salary and growth opportunities

Qualifications

• PharmD or Bachelor of Pharmacy degree required.
• Experience in managed care or utilization management preferred.
• Strong regulatory knowledge and documentation skills.

Responsibilities

• Review medication coverage appeals and grievances.
• Apply plan policies, guidelines, and regulations 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 compliance with rules.
• Contribute to process improvements for timeliness and quality.

Skills

Clinical judgment

Written communication

Regulatory compliance

Education

PharmD or Bachelor of Pharmacy

Job description

Pharmacy Careers seeks a Remote Appeals Pharmacist to review medication coverage appeals from home or hybrid settings. You will apply evidence-based guidelines, draft clinical rationales, and collaborate with clinicians to ensure fair access for members.

This fully remote role emphasizes strong documentation, regulatory attention, and a commitment to managed care principles. A PharmD or equivalent, and experience in managed care are preferred, with competitive salary and growth opportunities