Remote Prior Authorization Pharmacist - Appeals & Decisions
Oscar Health
Oscar Health is seeking a licensed pharmacist to review prior authorizations for medications. This remote role requires 3+ years of pharmacy experience and strong clinical knowledge. Responsibilities include making authorization decisions, conducting peer consultations, and ensuring compliance with regulations. Benefits include medical, dental, vision, and annual bonuses. The ideal candidate holds a Pharm.D. degree and an active pharmacist license. Occasional travel for team meetings is required. #J-18808-Ljbffr
$40.87 - $80.43 per hour
...Pharmacist Position At UnitedHealthcare, we're simplifying... ...flexibility to work remotely* from anywhere within... ...clinical status for appeals requests Conduct... ...to render appeal decision Provide explanations... ...Determinations (prior authorization) or member appeals...Remote workHourly payWork experience placement- A healthcare management company is seeking a Remote Coverage Review Pharmacist located in Tennessee. This role requires a Doctor of Pharmacy... ...be responsible for reviewing medication-related prior authorizations, appeals, and grievances, working independently or in a team...Remote work
- ...confidential managed care organization in New Hampshire is seeking an Appeals Pharmacist to review and process medication coverage appeals. The role... ...for patients, applying clinical knowledge to support fair decisions, and collaborate with healthcare professionals. Competitive...Remote work
- ...Appeals Pharmacist – Ensure Fair Medication Access for Patients A confidential... ...ensure fair, evidence-based decisions. Key Responsibilities... ...license in the U.S. Prior managed care or utilization... ...roles offer hybrid or fully remote options. Rewards: Competitive...Remote work
- ...About the job Remote Coverage Review Pharmacist Remote Coverage Review Pharmacist needs... ...coverage reviews and appeals including the review of medication related prior authorizations, pharmacy appeals, and member... ...Builds and maintains decision trees in the prior authorization...Remote workWork at office
- ...consultation on medication requests, prior authorizations, and benefit determinations... ...complex case reviews and appeals with accurate clinical... ...we look for ~ Active Pharmacist license in good standing (PharmD... ...Every medication decision we make affects someone’s health...Remote work
- ...Description: ~ The clinical pharmacist is an operation based role... ...data collected to perform prior authorization for specialty medications.... ...review of Medicare appeals cases. Review internal... ...for clinical information to decision cases Utilize work instructions...Remote workContract work
- ...consultation on medication requests, prior authorizations, and benefit determinations... ...complex case reviews and appeals with accurate clinical... ...current, and unrestricted pharmacist license in PA, TN, and/or... ...important Every medication decision we make affects someone’s...Remote work
$60 - $70 per hour
...Patient Care! Location: Remote – U.S. (All States... ...recruiting several clinical Pharmacists to support a leading... ...in the review and decision-making process for pharmacy drug authorizations and appeals . This fully remote opportunity... ...determinations for prior authorization and...Remote workContract workTemporary workFlexible hoursShift workWeekend work$80.41k - $156.8k
...Healthcare is hiring for a Pharmacist in our UM/Prior Authorization department. Candidates... ...starting. This position is remote and can be worked from a... ...coverage determinations and appeals in a timely, compliant,... ...coverage determination decisions. Works with leadership...Remote workWork experience placementShift work- ...medication coverage determination for prior authorization review and appeals. Through the Utilization Review... ...beyond medical policy review to make decisions on medication coverage requests.... ...CERTIFICATIONS Required Registered Pharmacist Preferred None SKILLS Oral & Written...Remote workFor contractorsWork at officeLocal area
$120k - $125k
...Overview The Clinical Care Pharmacist plays a vital role in... ...for reviewing prior authorization requests, supporting... ...clinical background, sound decision-making, and a... ...& Schedule Location: Remote Shifts 7a-4p EST 9a-6... ...prior authorizations, appeals, and override requests...Remote workFull timeContract workShift workWeekend work$125k
...Remote Judi Health is an enterprise health technology... ...The Clinical Care Pharmacist plays a vital role in... ...for reviewing prior authorization requests, supporting... ...role combines clinical decision-making with a strong... ...prior authorizations, appeals, and override requests...Remote workTemporary workLocal areaWeekend work$53 per hour
...Line Staffing is now hiring Clinical Pharmacist – Prior Authorization / Medicare (Remote) in United States. The Clinical... ...coverage determinations, and Medicare appeals Evaluate clinical documentation to support approval/denial decisions Ensure compliance with CMS...Remote workHourly payFull timeContract workImmediate startMonday to FridayShift work$44.6k - $59.75k
...receiving verbal and written requests for prior authorization from pharmacists, physicians and/or members. They... ...satisfied Process complaints, appeals, grievances, executive inquiries... ...considered in making compensation decisions, including but not limited to: education...Remote workLive inWork at officeLocal area- ...in Lexington is seeking an experienced Appeals Pharmacist to ensure fair access to medications for... ...professionals to make evidence-based decisions. Ideal candidates hold a PharmD and possess... ...compensation and flexibility, including potential remote options. #J-18808-LjbffrRemote work
$122.2k - $174.6k
...Senior Manager, Prior Authorizations (Pharmacist) - Missouri It takes great medical... ...authorization, pharmacist appeals, and peer-to-peer DLP... ...coverage and PDL placement decisions What we're looking for... ...expect in this role This is a remote position within Missouri,...Remote workPermanent employmentFull timeFlexible hours- ...confidential managed care organization is seeking an experienced Appeals Pharmacist in Connecticut. This role involves reviewing and processing... ...while leveraging clinical knowledge to advocate for fair decisions. The ideal candidate holds a PharmD and an active pharmacist...Remote work
- ...confidential managed care organization is seeking an experienced Appeals Pharmacist in Anchorage, Alaska, to advocate for patients and ensure... ...with healthcare professionals to make evidence-based decisions. Ideal candidates will have a PharmD, an active pharmacist license...Remote work
- ...confidential managed care organization is seeking an experienced Appeals Pharmacist to review and process medication coverage appeals. The ideal... ...critical thinking skills to ensure fair and evidence-based decisions. Responsibilities include reviewing clinical documentation,...Remote work
- A confidential managed care organization is seeking an Appeals Pharmacist to ensure fair medication access for patients. In this role, you... ...collaborate with healthcare professionals to ensure evidence-based decisions. Qualified candidates should hold a PharmD or Bachelor of...Remote workFlexible hours
$130k - $160k
...access by assisting with prior authorizations, drug therapy appeals, financial assistance,... ...Brigham values to govern decisions, actions and behaviors.... ...medication needs or, Clinical Pharmacist hospital practice... ...160K annually. Remote Type Hybrid Work...Remote workFull timeWork at officeImmediate startWork from homeFlexible hoursShift work2 days per week1 day per week- ...Pharmacy Appeals Department Position Work Mode: 100% Remote - in the U.S. SHIFT: Mon - Fri 9am – 6pm EST, No... ...– Dept 247 Review completed prior authorization requests received from the provider... ...previous prior authorization decisions. Verify coverage in member's...Remote workWork at officeShift work
- ...Position Title: Clinical Pharmacist 1 Work Location: Remote Assignment Duration:... ...Context: Pharmacy Appeals Department - Dept 247. Inclusive... ...team effort. Reviews prior authorization requests and evaluates... .... Supports formulary decisions and P&T Committee....Remote workWork at office
$55 - $60 per hour
...clinically driven Managed Care Pharmacist to join a remote healthcare team... ...experience, expertise in prior authorizations and drug utilization review... ...Conduct prior authorizations, appeals, audits, and clinical... ...disability, reproductive health decision making, medical condition...Remote workHourly payContract workLocal areaMonday to FridayShift work- CommuniCare Health is seeking a Pharmacy Prior Authorization Specialist for a full-time remote role. This position involves managing the Prior Authorization workflow for facilities in states including Ohio and West Virginia. The successful candidate will submit prior authorizations...Remote jobFull time
$97.8k - $133.46k
...committee activities. Supports prior authorization program by handling prior... ...by other clinical Pharmacists for the residents and students... ...timely review of Pharmacy appeals. Assists in the creation... ...Demonstrated ability to make decisions with little need for direction...Remote workLive inLocal area$121.6k - $164.5k
...Clinical Pharmacist Consultant Work from home within Oregon... ...or guiding clinical decisions based on best practices by... ...for medications subject to prior authorization, appeals, retrospective claim reviews... ...comprehensive member care. #LI-Remote The expected hiring...Remote workImmediate startWork from homeFlexible hours- A confidential managed care organization is seeking an Appeals Pharmacist to review medication coverage appeals. This individual will leverage... ...clinical knowledge to advocate for patients, ensuring fair decisions. Responsibilities include reviewing clinical documentation,...Remote job
- ...A confidential managed care organization is seeking a Remote Prior Authorization Pharmacist to evaluate prescription requests and ensure medical necessity... ...reviewing prior authorization requests, communicating decisions, and collaborating with healthcare professionals....Remote workWork from home
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