Remote Clinical Pharmacist – Managed Care Appeals

HireTalent; United States; Remote; USD 100,000 - 150,000; Full time

Job summary

HireTalent is seeking a Clinical Pharmacist to join our fully remote managed care team. In this role you will review and render decisions on authorizations and appeals for specialty, non-specialty, and physician-administered drugs, collaborating with prescribers as needed.

You will ensure safe, appropriate drug use for members and providers while complying with regulations. The ideal candidate has a PharmD, 3+ years of pharmacy practice, and willingness to obtain licensure in new states.

Qualifications

• PharmD degree required.
• 3+ years licensed pharmacist experience.
• Willingness to obtain licensure in new states as needed.
• Nice to have: 3+ years clinical review in managed care and writing clinical criteria.

Responsibilities

• Review and render decisions on authorizations and appeals.
• Conduct peer-to-peer calls with prescribers to discuss rationale.
• Participate in clinical quality audits and reliability testing.
• Provide internal team support for escalations and clinical questions.
• Apply clinical expertise to ensure safe drug use for members and providers.
• Maintain compliance with laws and regulations.

Skills

Clinical Pharmacist

Prior authorizations

Appeals review

Quality audits

Education

Doctor of Pharmacy (PharmD)

Job description

HireTalent is seeking a Clinical Pharmacist to join our fully remote managed care team. In this role you will review and render decisions on authorizations and appeals for specialty, non-specialty, and physician-administered drugs, collaborating with prescribers as needed.

You will ensure safe, appropriate drug use for members and providers while complying with regulations. The ideal candidate has a PharmD, 3+ years of pharmacy practice, and willingness to obtain licensure in new states.