Senior Clinical Pharmacist — Appeals & UM (Remote)

TruDataRx, Inc.; United States; Remote; USD 110,000 - 140,000; Full time

Job summary

TruDataRx, Inc. is seeking a Clinical Pharmacist II to evaluate and adjudicate complex drug coverage requests, with emphasis on high-touch peer-to-peer reviews with prescribing physicians.

This remote, full-time role requires exceptional telephonic communication, clinical negotiation, and the ability to articulate clinical rationales clearly to providers and members.

Strong knowledge of formulary criteria, regulatory timelines, and collaboration with cross-functional teams is essential.

Qualifications

• PharmD 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 preference for clinical appeals.
• Telephonic communication excellence and clinical negotiation skills are required.

Responsibilities

• Evaluate and adjudicate first- and second-level clinical appeals and complex drug coverage requests.
• Utilize comparative effectiveness data and literature to determine medical necessity.
• Document all discussions, rationales, and determinations in the UM system.
• Conduct Peer-to-Peer reviews with prescribing physicians and providers.

Skills

Telephonic communication

Clinical negotiation

Remote productivity

Education

Doctor of Pharmacy (PharmD)

Active pharmacist license

Tools

Medi-Span

First Databank

Job description

TruDataRx, Inc. is seeking a Clinical Pharmacist II to evaluate and adjudicate complex drug coverage requests, with emphasis on high-touch peer-to-peer reviews with prescribing physicians.

This remote, full-time role requires exceptional telephonic communication, clinical negotiation, and the ability to articulate clinical rationales clearly to providers and members.

Strong knowledge of formulary criteria, regulatory timelines, and collaboration with cross-functional teams is essential.