Remote PA Pharmacist - Appeals & Coverage Expert

Insight Global; United States; A distancia; USD 120.000 - 150.000; Jornada completa

Descripción de la vacante

Insight Global is seeking a Pharmacist, Prior Authorization & Appeals, to review PA requests and determine coverage based on clinical guidelines and plan benefits. You will work closely with physicians, pharmacy staff, and internal teams to ensure compliant, cost-effective therapies while meeting productivity and quality targets.

Remote-capable, with minimal supervision, you must have a current state license and Bachelors or Doctor of Pharmacy degree; 6+ months of healthcare customer service

Formación

• Pharmacist licensed in the state of work.
• 6+ months of healthcare customer service.
• Technology savvy and able to work remotely with minimal supervision.
• Comfortable in a production-based, high-volume environment.

Responsabilidades

• Review and evaluate prior authorization and appeals requests to determine coverage based on clinical guidelines, pharmacy policies, and health plan benefits.
• Collaborate with physicians, healthcare providers, pharmacy technicians, and internal teams to gather and assess clinical information and make evidence-based coverage determinations.
• Recommend formulary-compliant and cost-effective treatment alternatives while ensuring compliance with federal and state regulations.
• Document decisions per internal protocols, auditing standards, and confidentiality policies; manage case workload with daily priorities and productivity targets.

Conocimientos

Customer service

Technology savvy

Remote work capability

Team collaboration

Educación

Bachelor's or Doctor of Pharmacy

Active State Pharmacist License

Descripción del empleo

Insight Global is seeking a Pharmacist, Prior Authorization & Appeals, to review PA requests and determine coverage based on clinical guidelines and plan benefits. You will work closely with physicians, pharmacy staff, and internal teams to ensure compliant, cost-effective therapies while meeting productivity and quality targets.

Remote-capable, with minimal supervision, you must have a current state license and Bachelors or Doctor of Pharmacy degree; 6+ months of healthcare customer service