Remote Clinical Pharmacist: Appeals & UM Specialist

TruDataRx, Inc.; United States; Remote; USD 110,000 - 150,000; Full time

Job summary

TruDataRx, Inc. seeks a Clinical Pharmacist II to evaluate and adjudicate complex drug coverage requests, perform second-level reviews, and manage clinical appeals.

This role requires clear clinical rationale, strong telephonic negotiation, and ability to work with prescribing physicians and members in a remote setting. Responsibilities include appeals adjudication, peer-to-peer reviews, and meticulous documentation within the UM platform.

Qualifications

• Doctor of Pharmacy degree from an accredited institution.
• Active, unrestricted pharmacist license in your state of residence.
• 1–2 years of direct experience in managed care, utilization management, or PBM operations, with a focus on clinical appeals.

Responsibilities

• Evaluate, research, and adjudicate first- and second-level clinical appeals and complex drug coverage requests.
• Conduct Peer-to-Peer telephonic reviews with prescribing physicians and advanced practice providers.
• Document all discussions and final determinations within the UM platform.

Skills

Clinical documentation

Phone communication

Clinical negotiation

Remote productivity

PBM systems knowledge

Education

PharmD degree

State pharmacist license

Tools

Medi-Span

First Databank

UM platform

Job description

TruDataRx, Inc. seeks a Clinical Pharmacist II to evaluate and adjudicate complex drug coverage requests, perform second-level reviews, and manage clinical appeals.

This role requires clear clinical rationale, strong telephonic negotiation, and ability to work with prescribing physicians and members in a remote setting. Responsibilities include appeals adjudication, peer-to-peer reviews, and meticulous documentation within the UM platform.