Appeals Pharmacist (Remote)

Remote Appeals Pharmacist – Fair Medication Access

Work from home with a strong clinical writing focus. Combine clinical expertise with advocacy in a fully remote Appeals Pharmacist role. Review medication coverage appeals, apply evidence-based guidelines, and ensure fair determinations for members — all from home with a schedule that supports better work-life balance. Key responsibilities include:

• Review clinical documentation for medication coverage appeals and grievances.
• Apply plan policies, evidence-based guidelines, and regulatory requirements to reach determinations.
• Prepare clear written clinical rationales supporting appeal outcomes.
• Collaborate with physicians, nurses, and medical directors during case reviews.
• Track and report appeal outcomes in full compliance with state and federal rules.
• Contribute to process improvements that enhance timeliness and quality.

What you'll bring:

• Education: PharmD or Bachelor of Pharmacy.
• Licensure: Active U.S. pharmacist license.
• Experience: Managed care or utilization management preferred. Hospital, ambulatory, and community pharmacists with strong documentation and clinical skills are encouraged to apply.
• Skills: Excellent clinical judgment, written communication, and regulatory attention to detail.

Why this role?

• Fully remote or hybrid options available.
• Play a critical role in ensuring patients receive fair access to necessary medications.
• Build expertise in appeals, utilization management, and managed care.
• Competitive salary, comprehensive benefits, and advancement paths.

About us: We are a confidential healthcare partner working with health plans and managed-care organizations nationwide. Our appeals pharmacists protect patient access while upholding regulatory standards. Join our team as a Remote Appeals Pharmacist and help ensure every member receives a fair, evidence-based review.