Remote PBM Clinical Pharmacist - Appeals & Coverage
SlateRx
- Remote job
SlateRx is seeking a Clinical Pharmacist to review coverage determinations and appeals under our policies. This remote role supports employer groups and payers nationwide. You will interpret guidelines, communicate decisions to prescribers and members, and collaborate with PA technicians and clinicians to ensure accurate, timely, and patient-friendly explanations. Bachelor of Pharmacy or Pharm.D. required; active Pharmacist license in at least one state; prior authorization experience preferred; #J-18808-Ljbffr SlateRx
- SlateRx is seeking a Clinical Pharmacist to review coverage determinations and appeals in alignment with company protocols. You will collaborate with a team to support efficient, accurate, timely, and privacy-conscious decision making. Responsibilities include interpreting...Suggested
$135k - $145k
...Job Title Pharmacy Clinical Reviewer Job Description Fallon... ...provider/member submitted appeals and grievances for medically... ...developed criteria, National Coverage Determinations, and Local Coverage... ...license to practice as pharmacist in Massachusetts without restriction...Remote jobLocal area- ...plan sponsors and members. Job Overview: The Clinical Pharmacist is responsible for reviewing clinical coverage determinations and appeals in accordance with the criteria, policies... ...Knowledge in the healthcare, insurance or PBM industry. Experience working in a Prior Authorization...Suggested
$60 - $65 per hour
...Clinical Pharmacist I Duration: Contract (3 Months) Location: Remote Schedule: Monday Friday | 9:00 AM 6:00 PM EST... ...a remote Pharmacy Appeals team. In this role, you... ...make accurate and timely coverage decisions. Key... ...pharmacy benefit management (PBM). Knowledge of...Remote workHourly payContract workWork at officeMonday to Friday- ...Inc. uses objective clinical data to help... ...Management Clinical Pharmacist, you will join TruDataRx... ...determinations of coverage. In this role, you... ...and adjudicate appeal requests for... ...benefit management (PBM) operations. Clinical... ...case reviews. Remote Productivity: Self...Remote work
- ...Inc. uses objective clinical data to help... ...Summary The Clinical Pharmacist Operations Manager... ...authorization and appeals workflows. In... ...authorizations, complex coverage determinations,... ...Cloud, or specialized PBM claim processing... ...leading remote or hybrid clinical...Remote workShift work
- ...seamless and affordable care and coverage.Our work centers on creating... ..., and much more.The Clinical Pharmacist II for COMM/Exchange will be... ...and collaborating with the PBM on materials that will be presented... ...position is eligible for remote work from approved U.S. locations...Remote workFull timeWork at officeMonday to FridayFlexible hours
- ...Pharmacy Appeals Department – Dept 247 Location: 100% Remote - National SHIFT: 9am – 6pm EST Duration... ...and appeals coverage requests Department growth... ...request using professional clinical judgment on a case by case basis. A pharmacist will review medication requests...Remote workShift work
- ...Remote Appeals Pharmacist – Fair Medication AccessWork From Home | 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...Remote work
$50.48 - $84.62 per hour
...Position Summary The role of the Clinical Pharmacist in the Pharmacy Advisor team... ...and procedures. This is a remote role open to qualified... ...in Retail, LTC, Hospital or PBM pharmacy experience, or other... ...medical, dental, and vision coverage, paid time off, retirement savings...Remote workHourly payFull timeTemporary workLocal areaFlexible hours$101.6k - $133k
...visit . Position Summary: Responsible for reviewing clinical coverage determination and appeals for different lines of business such as Commercial and... ...independently with minimal supervision, stay productive in a remote, high-volume, metric driven environment with shifting...Remote workWork at officeLocal areaFlexible hoursShift work$135k - $145k
...Utilization Management Pharmacist TrainerCharlotte,... ...accurate, up-to-date, clinically relevant, compliant with... ...prior authorization and appeals determinations in accordance... ...Benefit Management (PBM) setting.Previous... ...staying productive in a remote, high-volume, and...Remote workWork at officeLocal areaFlexible hours$45.43 - $76.15 per hour
...Summary Ready to take your Clinical Pharmacist skills to the next level with... ...authorization requests and render coverage determinations based on... ...as needed. This is a remote role open to qualified candidates... ...working as a pharmacist in a PBM setting. Current experience...Remote workHourly payFull timeTemporary workLocal area- ..., a San Diego-based pharmacy benefits manager, is seeking an Appeals Clinical Specialist to independently conduct clinical reviews of appeals... ...records, and apply clinical criteria to determine benefit coverage, ensuring accuracy, timeliness, and regulatory compliance. The...
$91.7k - $163.7k
...Clinical Lead For Utilization Management Optum is a... ...the flexibility to work remotely from anywhere within the... ...development of drug coverage policies Presentation... ...in Pharmacy Current pharmacist license in good standing Managed Care, PBM, health plan, or utilization...Remote jobMinimum wageFull timeWork experience placementWork at officeLocal area$126.5k - $158k
...Clearway Health is looking for a Clinical Pharmacist who will provide... ...authorizations, formulary management, appeals, and patient assistance... ...Provide guidance on insurance coverage and cost-effective medication... ...) This position includes a remote, weekend on-call rotation...Remote workWork at officeShift work- ...General Brigham Health Plan is seeking a Clinical Pharmacist II for COMM/Exchange to develop and... ...pharmacy formularies to ensure appropriate coverage and cost effectiveness. You will... ...committee activities and collaborate with the PBM to align clinical strategies with plan...Remote job
- Spectraforce Technologies is seeking a Clinical Pharmacist 1 for a remote, 3-month assignment. The role focuses on evaluating redetermination and appeals coverage requests, with duties spanning prior authorizations, data retrieval, and collaboration with physicians to ensure...Remote job
$65 - $68 per hour
...subject to change. Position: Clinical Pharmacist Reviewer Location: Remote Status: Part-time About J2... ...Medicare Part D reconsideration appeals and program integrity-related activities... ...to evaluate appeal cases, assess coverage eligibility, and support accurate...Remote workHourly payContract workPart timeFor contractorsWork at office- ...Clinical Pharmacist Specialist Be a part of a world-class academic healthcare... ...Indiana areas. This fully remote position will be focused on... ...that routinely require appeals and free drug to get treatment... .... There may also be a cross-coverage component for the 2 Clinical...Remote workFull timeRelocation packageFlexible hoursShift work
$53 per hour
...Job Description FULLY REMOTE - WORK FROM HOME, 40... ...Job Requirements: Pharmacist license in state of residence... ...authorization experience in PBM or managed care... ...with questions, interpret clinical guideline criteria, and render/review coverage determination for prior...Remote jobHourly payPermanent employmentContract workWork from homeMonday to Friday$140k - $160k
...Clinical PharmacistDepartment: Pharmacy Location: Sacramento... .... As a Clinical Pharmacist supporting Prior Authorization... ...environment—supporting coverage determinations,... ...authorization (PA), exception, and appeal requests—leveraging... ...clinical input on PBM strategies and P&T committee...Full timeWork at office$130k - $160k
...Clinical PharmacistHuntington Beach Office - Huntington... ...SummaryThe Clinical Pharmacist helps build and run a... ...with internal teams and PBM partners.As part of... ...review: Review Part D coverage determinations, formulary... ...Determinations, Appeals, and Grievances workflows...Work at office- ...Position Title Prior Authorization Clinical Pharmacist Job Description Prior... ...review and approve or deny coverage for pharmaceuticals (as permitted... ...of managed care pharmacy (PBM) experience or residency in... ...utilization review or an appeals consideration and cannot be...Full timeContract workTemporary workWork experience placementWork at officeLocal area1 day per week
- ...and members. Job Overview: As the Clinical Account Executive Pharmacist, you will serve as the primary clinical... ...and escalations involving formulary coverage, utilization management, specialty... ...experience in a client-facing managed care, PBM, health plan, consulting, or related...
- Position TitleAmbulatory Clinical Pharmacist - Cardiology (Hybrid)Medical PavilionPosition Summary... ...within our clinics in addition to having remote opportunities on average at least 1 day... ...scheduling in order to assist in coverage of supplemental shifts when primary team...Remote workFlexible hoursShift work1 day per week
$111.2k - $185.3k
...Founded and operated by a team of pharmacists and software engineers, we... ...prescription drugs. The Clinical Pharmacist - Sales primarily... ...consider a well-qualified fully remote individual. What You’ll Do:Provide... ...of pharmacyExperience with PBM clinical programs, specialty...Remote workFull timeTemporary workWork experience placementWork at officeLocal area- CVS Health seeks a Clinical Advisor (Pharmacist) to apply clinical expertise in a client-facing, managed care setting. You will support Aetna as part of the account team, analyze drug use trends, and deliver clinical reports to clients on plan design and outcomes. You...Remote job
- ...Job Description Senior Clinical Pharmacist Location: Birmingham, AL... ...with Quality Assurance (QA) of coverage determinations reviewed by the... ...requests, complaints, and appeals and ensure criteria and decisions... ...Benefit Manager(s) (PBM) and assist with clinical oversight...Work at officeImmediate startWork from homeFlexible hours
- ...UnitedHealth Group is seeking a Pharmacist PA/Appeals to support pharmacy prior authorization and appeals remotely for Maine and Vermont residents. The role emphasizes clinical judgment, accurate documentation, and adherence to HIPAA while coordinating with providers...Remote work
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