Remote Appeals Pharmacist for Fair Medication Access

Pharmacy Careers; Seattle (WA); Remote; USD 120,000 - 170,000; Full time

Job summary

Pharmacy Careers is seeking a fully remote Appeals Pharmacist to review medication coverage appeals and provide evidence-based determinations from home. A focus on clear clinical writing and regulatory compliance helps ensure fair access for members.

The role supports remote or hybrid arrangements nationwide, offering competitive compensation, comprehensive benefits, and clear advancement paths for experienced pharmacists.

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 fully remote Appeals Pharmacist to review medication coverage appeals and provide evidence-based determinations from home. A focus on clear clinical writing and regulatory compliance helps ensure fair access for members.

The role supports remote or hybrid arrangements nationwide, offering competitive compensation, comprehensive benefits, and clear advancement paths for experienced pharmacists.