Remote Coverage Review Pharmacist Appeals & Compliance
Global Channel Management
A healthcare management company is seeking a Remote Coverage Review Pharmacist located in Tennessee. This role requires a Doctor of Pharmacy (PharmD) degree, clinical experience, and a solid understanding of regulatory guidelines. The Pharmacist will be responsible for reviewing medication-related prior authorizations, appeals, and grievances, working independently or in a team to deliver quality pharmaceutical services. Excellent communication and organizational skills are essential for this position. #J-18808-Ljbffr
- Pharmacy Careers is seeking a fully remote Appeals Pharmacist to review medication coverage appeals and provide evidence-based determinations from home. A focus on clear clinical writing and regulatory compliance helps ensure fair access for members. The role supports...Remote jobWork from home
- ...About the job Remote Coverage Review Pharmacist Remote Coverage Review Pharmacist needs 3 years and Doctor... ...with coverage reviews and appeals including the review of medication related... ...criteria and ensures that decision letters meet regulatory compliance #J-18808-LjbffrRemote workWork at office
- ...Remote Appeals Pharmacist – Fair Medication Access Work from home with a strong clinical writing... ...remote Appeals Pharmacist role. Review medication coverage appeals, apply evidence-based... ...and report appeal outcomes in full compliance with state and federal rules. Contribute...Remote workWork from home
- Pharmacy Careers is seeking a Remote Appeals Pharmacist to ensure fair access to medications. You will review clinical documentation for coverage appeals from home and provide evidence-based determinations. This role supports managed care through strong documentation, clinical...Remote jobWork from home
- Pharmacy Careers is seeking a Remote Appeals Pharmacist to review medication coverage appeals from home, applying evidence-based guidelines and regulatory requirements to reach fair determinations. This role emphasizes strong clinical writing and collaboration with physicians...Remote jobWork from home
$40.87 - $80.43 per hour
...Pharmacist At UnitedHealthcare, we're simplifying the... ...flexibility to work remotely* from anywhere within... ...and clinical status for appeals requests Conduct Quality... ...area of expertise Review formulary and... ...provider appeals of pharmacy coverage decisions Gather...Remote workHourly payWork experience placement$44 - $79 per hour
...interactions, and clinical status for appeals requests Conduct Quality... ...within area of expertise Review formulary and utilization... ...provider appeals of pharmacy coverage decisions Gather complex... ...~ Active and unrestricted Pharmacist license in your state of residence...Remote workHourly payMinimum wageFull timeWork experience placementLocal areaMonday to Friday- Pharmacy Careers is seeking a Remote Drug Utilization Review (DUR) Pharmacist to analyze medication use patterns, apply clinical guidelines, and collaborate... ...for prescribers to optimize therapy while ensuring compliance with state and health-plan requirements. #J-18808-...Remote job
- Pharmacy Careers is seeking a Remote Appeals Pharmacist focused on fair medication access. This... ...remote or hybrid role involves reviewing medication coverage appeals, applying evidence-based... ...medical directors, ensure regulatory compliance, and help advance appeals and...Remote job
$101.6k - $133k
...Position Summary: Responsible for reviewing clinical coverage determination and appeals for different lines of business... ...supervision, stay productive in a remote, high-volume, metric driven environment... ...including the reporting of non-compliance. This position description is...Remote workTemporary workWork at officeLocal areaFlexible hoursShift work$59 per hour
...Description Job Description Remote Prior Authorization and Appeals Pharmacist Compensation: $59/... ..., is responsible for reviewing and evaluating prior... ...requests to determine coverage based on clinical... ...alternatives, and ensure compliance with federal and state...Remote jobContract workLocal areaImmediate startShift work$70 per hour
...PharmD USA, LLC is a leading provider of remote and on-site clinical pharmacy... ...nationwide. Our team of experienced pharmacists provides comprehensive medication management, regulatory compliance support, and clinical chart reviews to ensure patient safety and quality...Remote workHourly payDaily paidPart timeLocal areaFlexible hours- ...Pharmacist needed for Remote / Work From Home Position! Multiple openings with aSeptember... ...Description: Evaluate and review all prior authorization requests and render coverage determinations based on... ...Medicare Part D requests, in compliance with Medicare guidelines, while...Remote workHourly payFull timeWork at officeWork from homeHome officeMonday to Friday
- Piper Companies is seeking a Clinical Appeals Nurse for a fully remote healthcare-based opportunity. This Clinical Appeals Nurse... ...a long-term contract role focused on clinical review, appeal resolution, regulatory compliance, and member/provider support within a complex health...Remote jobLong term contract
- ...Remote Case Management PharmacistCoordinate care for... ...through medication reviews, care coordination, and... ...remote setting. Ideal for pharmacists who enjoy clinical... ...prior-authorization and appeals processes when needed.... ...and outcomes in compliance with health-plan and regulatory...Remote work
- UnitedHealthcare is seeking a pharmacist to evaluate prescriptions, interpret clinical documentation, and provide expert guidance on drug utilization. The role requires a licensed PharmD with at least 1 year of pharmacist experience, strong record-keeping, and proficiency...Remote jobMonday to Friday
- ...Summary The Clinical Pharmacist Operations Manager... ..., regulatory compliance, operational... ...authorization and appeals workflows. In addition... ...authorizations, complex coverage determinations,... ...and clinical review queues. Escalation... ...Experience leading remote or hybrid clinical...Remote workShift work
$60 - $70 per hour
...Health is hiring a Drug Utilization Review Pharmacist for a well-known client! (REMOTE) * Remote Opening : for the... ...-related issues, and maintaining compliance with applicable federal and state... ...employee’s comprehensive healthcare coverage (medical, dental, and vision...Remote jobContract workLocal areaWork from homeShift workNight shiftAfternoon shift$128k - $160k
...prior authorization and appeals operations that are... ...of prior authorization pharmacists, staff schedules, skilling... ...and managing compliance risks. Position Responsibilities... ...and appeal reviews, override requests, and... ...leadership experience in a remote environment. This...Remote workContract workWork at officeLocal areaMonday to FridayFlexible hoursShift workWeekend work- ...Remote Prior Authorization Pharmacist Work From Home | Flexible Schedule | High Clinical Impact Transition... ...Authorization Pharmacist role. Review medication requests from home, apply... ...cases. Document all decisions in compliance with CMS, state, and health-plan requirements...Remote workWork from homeFlexible hoursAfternoon shift
- ...Remote, AZ Contract Job Title: Pharmacist Location: Remote Duration: 12+ months contract Job Description... ...set up for our members, review clinical information for decisioning... ...all Medicare Part D requests, in compliance with Medicare guidelines, while promoting...Remote workContract work
- ...Key Responsibilities Review Medicare Part D coverage determination and appeals cases. Evaluate clinical documentation and internal case notes for completeness and accuracy. Contact healthcare providers to obtain additional clinical information when necessary. Apply clinical...Remote work
- ...immunizations or MTM interventions, ensuring the compliance with regulatory guidelines, company... ..., medication management, drug therapy reviews, and perform clinical, or wellness... ...The Product Review/Retail Fill Process Pharmacist is responsible for ensuring that elements...Remote workShift work
- ...The Pharmacist, Prior Authorization (PA) & Appeals, is responsible for reviewing and evaluating prior authorization... ...requests to determine coverage based on clinical guidelines... ..., and ensure compliance with federal and... ...responsibilities and duties remotely with little to no...Remote work
- Pharmacy Careers is seeking a Remote Prior Authorization Pharmacist to review medication requests from home, applying evidence-based criteria to determine medical necessity and plan compliance. Ideal candidates hold a PharmD or Bachelor of Pharmacy, with an active U.S....Remote jobWork from homeFlexible hours
- ...Solutions in Columbus, OH, is seeking an Appeals Nurse to review medical records and Medicare claims... ...to determine medical necessity and coverage alignment. The role collaborates with... ...document clinical rationales, and ensure compliance with CMS guidelines. A registered...Remote job
- ...Remote DUR Pharmacist Safe & Cost-Effective Medication Use Work From Home Analyze medication use... ...home. This remote Drug Utilization Review Pharmacist role is ideal for pharmacists... ...risk. # Document reviews and ensure compliance with state, federal, and health-plan requirements...Remote jobWork from home
- ...Remote Drug Utilization Review Pharmacist Safe & Cost-Effective Medication Use Work from home analyze medication use patterns, apply clinical guidelines... ...and reduce risk, documenting reviews and ensuring compliance with state, federal, and health-plan requirements, and...Remote jobWork from home
- ...healthcare intelligence company. The Medical Review Nurse II audits home health claims, working remotely with a multi-location team to ensure compliance and high-quality documentation. The... ...guidelines, and participate in the appeals process while staying current with...Remote jobWork from home
- ...culture, and its talent-first flexible/remote work approach, see below and visit About the Role: The Pharmacist, Quality Oversight & Compliance will serve as the primary point of... ...that complaints are thoroughly reviewed, investigated and reported according...Remote workFull timeWork experience placementLocal areaFlexible hours
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