Remote Prior Authorization Pharmacist — PA & Appeals

Insight Global; United States; On-site; USD 165,312,000 - 179,088,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

HSA

FSA

DCFSA

401k with employer matching

Paid time off

Job summary

Insight Global is seeking a Pharmacist, Prior Authorization & Appeals, to review and evaluate PA/appeals requests in a fast-paced, high-volume remote environment across the US. You will collaborate with physicians, pharmacy technicians, and internal teams to determine coverage based on guidelines and plan benefits.

The role requires strong clinical judgment, meticulous documentation, and effective communication, with full compliance to state and federal regulations.

Qualifications

• Pharmacist with Bachelors or Doctorate of Pharmacy and an active license.
• Currently licensed pharmacist in the state of work.
• 6+ months of customer service with healthcare professionals.
• Basic proficiency with Microsoft Excel, Word and Outlook.
• Comfortable in a production-based, remote work environment.
• Able to work remotely with little supervision in a fast-paced setting.
• Flexible and collaborative to meet changing business needs.

Responsibilities

• Review and evaluate prior authorization and appeals requests for coverage.
• Gather clinical information and make evidence-based determinations.
• Recommend formulary-compliant and cost-effective alternatives.
• Ensure compliance with federal and state regulations and policies.
• Document case decisions per internal protocols and confidentiality.
• Support quality assurance initiatives and process improvements.
• Coordinate with physicians, providers, and internal teams.

Skills

Customer service

Excel basics

Word basics

Outlook basics

Remote work

Adaptability

Team collaboration

Education

Bachelor of Pharmacy

Doctorate of Pharmacy

Active state license

Job description

Insight Global is seeking a Pharmacist, Prior Authorization & Appeals, to review and evaluate PA/appeals requests in a fast-paced, high-volume remote environment across the US. You will collaborate with physicians, pharmacy technicians, and internal teams to determine coverage based on guidelines and plan benefits.

The role requires strong clinical judgment, meticulous documentation, and effective communication, with full compliance to state and federal regulations.