Remote Clinical Pharmacist — PBM & Coverage Appeals

The Judge Group; Eden Prairie (MN); On-site; USD 74,000 - 105,000; Full time

Benefits offered by this job

Weekly pay

Medical insurance

Dental insurance

Vision insurance

Job summary

The Judge Group is seeking an experienced Clinical Pharmacist to support its PBM coverage determinations and appeals team in a remote capacity. The role emphasizes reviewing complex cases, gathering clinical data, and making evidence-based recommendations for Medical Directors in a fast-paced setting.

Ideal candidates will have PBM experience, Medicare Part D knowledge, strong navigation of clinical resources, and excellent communication in a remote environment.

Qualifications

• Active, unrestricted Pharmacist license.
• Proficient in clinical documentation and medical terminology.
• Experience using online clinical references and regulatory websites.
• Able to review electronic clinical documentation and scanned documents.
• Intermediate Microsoft Office skills.
• Capable of navigating multiple systems in Windows environment.
• Strong written and verbal communication, documentation, and organizational skills.

Responsibilities

• Evaluate prescriptions and patient histories to support pharmacy coverage determinations and appeals.
• Interpret physician prescriptions and assess clinical information using criteria, references, and guidelines.
• Review formulary policies and utilization management for coverage eligibility.
• Research and decide on member/provider appeals related to pharmacy benefits.
• Gather complex clinical information, including literature and policies, for decisions.
• Consult with physicians, members, and internal stakeholders about medication use and status.
• Collaborate with Medical Directors to support clinical decisions when needed.
• Conduct quality assurance to ensure regulatory and organizational standards.

Skills

Pharmacist license

Clinical documentation

Medical terminology

Regulatory knowledge

MS Office

Multi-system navigation

Communication skills

Education

PharmD degree

Pharmacy Residency

Job description

The Judge Group is seeking an experienced Clinical Pharmacist to support its PBM coverage determinations and appeals team in a remote capacity. The role emphasizes reviewing complex cases, gathering clinical data, and making evidence-based recommendations for Medical Directors in a fast-paced setting.

Ideal candidates will have PBM experience, Medicare Part D knowledge, strong navigation of clinical resources, and excellent communication in a remote environment.