Remote Appeals Pharmacist for Fair Medication Access

Pharmacy Careers; New Orleans (LA); Remote; USD 120,000 - 155,000; Full time

Job summary

Pharmacy Careers is seeking a Remote Appeals Pharmacist to review medication coverage appeals, apply evidence-based guidelines, and ensure fair determinations for members from home. You will craft clear clinical rationales and collaborate with physicians, nurses and medical directors during case reviews.

This fully remote role offers flexible scheduling, strong documentation requirements, and opportunities to grow in appeals and utilization management within managed-care settings.

Qualifications

• Pharmacist degree required.
• Experience in managed care or utilization management preferred.
• Strong documentation and clinical skills.

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

Education

PharmD

Bachelor of Pharmacy

Job description

Pharmacy Careers is seeking a Remote Appeals Pharmacist to review medication coverage appeals, apply evidence-based guidelines, and ensure fair determinations for members from home. You will craft clear clinical rationales and collaborate with physicians, nurses and medical directors during case reviews.

This fully remote role offers flexible scheduling, strong documentation requirements, and opportunities to grow in appeals and utilization management within managed-care settings.