Remote Pharmacy Prior Authorization Specialist - Appeals
Communicare Health Services
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, resolve discrepancies, and ensure compliance with federal and state regulations. Ideal for those with prior authorization or Long-Term Care pharmacy experience, offering comprehensive benefits including health insurance and a 401(k) match. #J-18808-Ljbffr
- ...Medication Access Specialist We are... ...in health system pharmacy—designing pharmacy... ...About The Role (Remote, Work From Home)... ...handling medication authorizations, managing insurance... ...documentation for prior authorization submissions... ..., escalating appeals for coverage...Remote workFull timeWork at officeWork from home
- ...performance through pharmacy. Our team of... ...add a Medication Specialist to our Specialty... ...ABOUT THE ROLE (Remote, work from home)... ...Reviewing medication authorizations submitted by clients... ...related to prior authorization submission... ...with submitting appeals related to...Remote workFull timeWork from home
- ...Remote, RI Contract Job Title: Prior Authorization Specialist Location: Fully remote Duration: 12 months contract... ...in-bound calls from providers, pharmacies, members, etc providing professional... ...Coverage Determinations and Appeals Learning Advocates and...Remote workContract work
- ...positions are classified as hybrid, onsite or remote. While the majority of our employees... ...to requests for member and provider appeals, grievances, reconsiderations and... ...focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical...Remote workFull timeContract workWork experience placementWork at officeLocal area1 day per week
- ...Sr. Reimbursement Specialist - Patient Access Services... ...insurance and pharmacy processes. The Sr. Reimbursement... ...coordinate benefits, prior authorizations, and product delivery... ...authorizations, and appeals is highly preferred.... .... Benefits: ~ Remote work opportunities...Remote workTemporary workWork at officeFlexible hours
$23 per hour
Pharmacy Prior Authorization Specialist - CareMed Specialty Pharmacy Houston, TX | Full-Time | Starting at $23... ...in the lives of cancer patients. Remote work possible after initial on-site... ...Manage prior authorization requests and appeals with insurance carriers....Remote workFull timeTemporary workRelocation package$75 per hour
...AI systems. We are seeking experienced Medication and Pharmacy Prior Authorisation specialists with expertise in speciality medication access to evaluate... ...to obtain timely medication authorisations. Manage appeals for denied pharmacy authorisations, including peer‑to‑peer...Remote job- ...Caremed-Specialty-Pharmacy in Houston, TX is looking for a Pharmacy Prior Authorization Specialist. This full-time position focuses on ensuring patients receive necessary... ...have at least 1 year of relevant experience. Remote work may be possible after initial training....Remote workFull timeRelocation package
- ...healthcare management company is seeking a Remote Coverage Review Pharmacist located in... .... This role requires a Doctor of Pharmacy (PharmD) degree, clinical experience,... ...for reviewing medication-related prior authorizations, appeals, and grievances, working independently...Remote work
- ...Dept: Pharmacy Help Desk Comm Will this position be required to work onsite for any reason at any time? Yes, up to... ...specialty drug benefits analysis, drug coverage inquiries and prior authorizations. High School Graduate of GED equivalent required. Two (2) years...Remote workWork at office1 day per week
$20 - $21.96 per hour
...Intake Specialist I Location US- ID 2025... ...Type Full-Time Remote Yes Company... ...Navitus - Innovative Specialty Pharmacy Solutions- Lumicera Health... ...insurance companies in triaging prior authorizations for patients of the...Remote workFull timeFlexible hoursShift work$23.49 - $30.53 per hour
...Pharmacy Technician You must reside in Colorado for this fully remote position. Work Schedule: Full Time, 80.00 hours per pay period (2 weeks) Shift: Days... ...to medications for patients by completing prior authorization requests (par), co-pay assistance programs,...Remote workFull timeTemporary workInternshipLocal areaFlexible hoursShift work$18.92 - $23.46 per hour
...Vital Care is the premier pharmacy franchise business with franchises... ...Perform duties to initiate authorizations, focusing on accuracy, timeliness... ...to complete and submit prior authorizations timely for payer... ...This position is full-time and remote. The salary range for this...Remote workFull timeContract workTemporary workLocal areaFlexible hours$18.92 - $23.46 per hour
.... Vital Care is the premier pharmacy franchise business with franchises... ...Perform duties to initiate authorizations, focusing on accuracy,... ...included to complete and submit prior authorizations timely for payer... ...position is full‑time and remote. The salary range for this position...Remote workFull timeContract workTemporary workLocal areaFlexible hours- Adecco US, Inc. is hiring remote pharmacists in Texas for a 6-month contract with the... ...serving as a clinical resource, handling prior authorization tasks, working flexible hours including... ...hold a Bachelor’s or Doctorate in Pharmacy and an active State Pharmacist License,...Remote jobFull timeContract workFlexible hours
$24.11 - $36.17 per hour
...Description Medication Access Specialist Lead - Specialty Pharmacy Location: UCHealth Admin Lowry... ...and does not offer a hybrid or remote option Summary: Leads team... ...or 1 year of experience performing prior authorizations or refill renewals. Employees...Remote workFull timeTemporary workLocal areaFlexible hoursShift work$23 - $27 per hour
Job Title Clearance Specialist - Full‑time, Remote (USA) Overview Soleo Health is... ...support our Specialty Infusion Pharmacy. Join us in simplifying... ..., and follow up on payer authorization requests. Perform benefit... ...Initiate, follow up, and secure prior authorization, pre‑...Remote jobHourly payFull timeContract workImmediate startMonday to Friday$75 per hour
...Jack Dorsey . Position: Pharmacy Prior Authorization & Specialty-Medication Access Specialist Type: Contract Compensation... ...: $75/hour Location: Remote Role Responsibilities... ...medication authorisations. Manage appeals for denied pharmacy...Remote jobContract workSummer work- ...challenges in health system pharmacy—designing pharmacy... ...THE POSITION (Remote) The Medication Access Specialist Supervisor is an... ...review medication authorizations, conduct benefits... ...documentation, submit prior authorizations, and support appeals for coverage...Remote workFull timeWork at office
$40.87 - $80.43 per hour
...enjoy the flexibility to work remotely* from anywhere within the U.... ..., and clinical status for appeals requests Conduct Quality... ...member and provider appeals of pharmacy coverage decisions Gather... ...in Coverage Determinations (prior authorization) or member appeals...Remote workHourly payWork experience placement- ...TeamHEALTH is looking for a Denials and Appeals Representative to handle denials and appeals for patient accounts in a cooperative team environment. The ideal candidate has at least two years of experience with insurance denial processes. Responsibilities include processing...Remote work
- ...L.A. Care Health Plan is seeking an Appeals and Grievances Specialist II in Los Angeles, CA. The role involves investigating member and provider complaints, ensuring compliance with various health regulations, and preparing reports. Requirements include at least 2 years...Remote workFull time
- ...Elevance Health is seeking a Grievance/Appeals Representative I to work virtually from Grand Prairie, Texas. This position involves investigating customer grievances and appeals related to service coverage while managing communications with customers and regulatory agencies...Remote work
- ...Geisinger is seeking a dedicated professional to support the administration of the Appeals and Grievance process. The role involves acting as a liaison between members and the Plan regarding denied claims, services, and other concerns. Responsibilities include managing...Remote work
- ...Elevance Health in Tampa, Florida seeks a Grievance/Appeals Representative I to manage customer claims and ensure resolution of grievances. This role primarily involves analyzing and processing claims, with a significant focus on communication and documentation. The ideal...Remote workFlexible hours
- ~ Submits, tracks, and manages prior authorization requests for medical and ancillary procedures... ...providers, and insurance payers to file appeals or facilitate a P2P. ~ Reviews... ...previous experience as a Prior Authorization Specialist, with expertise in medical billing,...Remote workWork at office
$21.16 - $38.37 per hour
...Join to apply for the Medicare Appeals & Grievances Specialist (PST Hours) role at Molina Healthcare . This position is remote and will be working Pacific Standard hours. Highly Qualified Candidates Will Have The Following Experience Strong understanding of...Remote workHourly payFull timeContract workWork experience placementWork at office- ...PHIL is looking for a full-time Prior Authorization Specialist - with a focus on pharmacy support for Monday through Friday... ...assist providers in navigating appeals processing Ensures all pertinent... ...speed internet to meet the needs of remote processing (required) Reliable...Remote workFull timeWork at officeMonday to FridayShift work
- ...Member And Provider Complaint Resolution Specialist 100% remote candidates must live in one of the... ...resolution to members and provider (or authorized representatives) in accordance with the... ...research and resolution of the appeals, dispute, grievances, and/or complaints...Remote workContract workLive inMonday to Friday
- Maximus is seeking a Senior Appeals Administrator for their California Independent Medical Review team. This role is vital in ensuring timely resolutions for medical review cases while enhancing the appeals process. The ideal candidate will have an associate degree with...Remote jobWork from homeFlexible hours
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