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
- ...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
$80k - $90k
...Range: $80-90k The Medical Review Clinical Appeals Auditor (RN) is... ...anti-harassment and other compliance and policy/procedures training... ...programs, particularly the coverage and payment rules and regulations... ...to work independently in remote setting with minimum supervision...Remote workFor contractorsImmediate startWork from homeHome officeFlexible hoursShift work- ...Appeals Pharmacist - Ensure Fair Medication Access for Patients... ...Appeals Pharmacist to review, evaluate, and process medication coverage appeals. This role is... ...report appeal outcomes in compliance with state and federal... ...offer hybrid or fully remote options. Rewards:...Remote work
- ...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
- ...Pharmacist Job Duration: 12+ months (possibilities... ...providers by processing coverage-related requests for injectable... ...accurate case set up, review of clinical... ...Medicare Part B requests, in compliance with Medicare... ...position is full-time, remote, non-exempt, and requires...Remote workFull timeMonday to FridayShift 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$123.5k
...seeking a Clinical Nuclear Pharmacist to join the Nuclear... ..., regulatory compliance, and continuous improvement... ...Employer-paid medical coverage starting day one for employees... ...and therapeutic use. Review orders for indication,... ...: Hybrid Onsite/Remote Pivotal Position: Yes...Remote workFull timeTraineeshipWork experience placementWork at officeLocal areaRelocation packageWeekend work- ...ABOUT THE POSITION (Remote, Occasional Travel Required) The Pharmacist Manager, Medication Access... ...processes, utilization review, and affordability strategies... ...clinical and coverage-related challenges and resolution... ...necessity evaluations, appeals, and reimbursement...Remote workFull timeWork at office
- ...Remote Pharmacovigilance Pharmacist - Ensure Drug Safety from Home A confidential pharmaceutical organization... ...support drug safety and regulatory compliance. This work-from-home role allows... ...products. Conduct literature reviews and safety signal detection...Remote workWork from homeFlexible hours
- ...Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications A confidential... ...risk. Document reviews and ensure compliance with state, federal, and health plan... ...Many DUR roles offer hybrid or fully remote schedules. Rewards: Competitive...Remote work
- ...Job Title: Pharmacist Location: Remote Duration: 12+ months contract Job Description: ~... ...accurately set up for our members, review clinical information for decisioning... ...of all Medicare Part D requests, in compliance with Medicare guidelines, while promoting...Remote workContract work
- ...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
- ...leading closed-door pharmacy provider in Colorado Springs seeks a remote Pharmacist Consultant to manage medication therapy and optimize care... .... Responsibilities include evaluating medication orders, reviewing residents’ drug regimens, and documenting communications with...Remote workFlexible hours
$24.79 per hour
...Member Appeals Specialist Trillium Professional... ...Specialist for a 100% remote position! Candidates... ...pre-service pharmacy coverage for non-Medicare health... ...resolution while ensuring compliance with regulatory... ...40 active appeals. Review appeals for timeliness...Remote workWork at officeMonday to Friday$57 per hour
ProPivotal Staffing is seeking a Clinical Pharmacist Reviewer to work from home in Massachusetts. This role supports clinical pharmacy services and involves optimizing treatments with healthcare teams. Candidates should have 1-2 years of experience and an active Massachusetts...Remote workHourly payWork from homeFlexible hours- ...Title: Registered Nurse - Claims & Appeals Review Location: Remote (Anywhere in Florida) Duration: 06 Months... ...for ensuring the accuracy, compliance, and timeliness of appeal reviews through... ...for appeals turnaround time, audit coverage, and accuracy. Support calibration sessions...Remote workContract workDay shift
$90k - $99k
...DRG Nurse Reviewer Appeals and Hearings- Remote Date: Jan 9, 2026 Location: Any city, FL, US, 99999 Work Mode: Virtual (Exception only) It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and...Remote workFull timeWork from homeFlexible hours- ...Description Job Summary PHARMACIST *AUTO OFFER*... ...specialty campus Weekend Coverage Required? Yes, every other... ...for medical review, and supervises and directs... ...timely manner and in compliance with department and hospital... ...activities, remote order verification, and...Remote workContract workWork experience placementWork at officeShift workNight shiftWeekend work
- ...clinicians because we are clinicians! About the role The Clinical Pharmacist is responsible for the processing and documenting of... ...care providers concerning non-formulary and clinical product coverage issues. Collaborate with team members to promote consistency...Remote workPermanent employmentContract workLocal area
- ...Location: Florida - Remote WHY JOIN FCS At Florida... ...hybrid opportunity for Oncology Pharmacists residing and licensed in the... ...drug utilization monitoring and compliance. Provides support for the... ...- Pharmacoinformatics Reviews drug utilization reports alongside...Remote workPrivate practiceWork at officeLocal areaWork from home
- ...Working remotely in a full-time capacity, the Behavioral Health Utilization Review Specialist will manage the authorization of treatment through insurance... ...pre-certification, concurrent, and appeal reviews while ensuring compliance with relevant regulations. Key Responsibilities...Remote workFull time
- A healthcare solutions provider is seeking a Remote Pharmacist to conduct VA quality reviews, focusing on clinical assessments without direct patient interaction. Candidates must have a Doctor of Pharmacy (PharmD) and an active pharmacist license in the U.S. Responsibilities...Remote jobFlexible hours
$90k - $99k
A leading healthcare solutions provider seeks a DRG Nurse Reviewer Appeals and Hearings to coordinate appeal duties and engage in hearings,... ...must have an active RN license and coding certification. This remote role offers flexibility and opportunities for career...Remote workFlexible hours$29 - $52 per hour
...UnitedHealth Group is seeking a qualified Registered Nurse in Massachusetts to perform clinical coverage review services. As part of this role, you will communicate benefit determinations and work closely with healthcare providers to explain coverage. We offer telecommuting...Remote workHourly pay- ...mission of delivering high-quality at-home care, the full-time remote Medical Review Nurse will ensure compliance with CMS regulations for surgical dressing orders, manage pre-bill controls, and lead audit and appeals processes. Key responsibilities Interpret and...Remote workFull time
- ...Appeal & Grievance Coordinator Reviewer I We are seeking an Appeal & Grievance Coordinator Reviewer I to review and research medical appeals and grievances... ...and medical records, and ensure timely resolution in compliance with HIPAA, CMS, and regulatory guidelines. The ideal...Remote workWork at office
- ...healthcare services company is seeking a physician reviewer to utilize clinical expertise in reviewing insurance appeals and claims. This telework opportunity allows for a customizable schedule while ensuring compliance with client-specific policies. Candidates must...Remote workContract workFor contractors
$246.1k - $344.2k
...relies on medical background and reviews health claims. You will work... ...healthcare professionals in compliance with review policies,... ...medical decisions on complex appeal cases, exercising professional... ...duplicate profiles. This is a remote position anywhere in the USA...Remote workFull timeTemporary workFor contractorsApprenticeshipInterim roleWork at officeWork from homeHome officeMonday to Friday- ...HEALTHWEALTH PHARMACY is hiring a Remote Pharmacist to support multi-state licensing and ensure compliance across operations. You will work flexibly from home, focusing on remote verification and oversight without the chaos of a physical pharmacy. The ideal candidate...Remote workWork from homeFlexible hours
$60.78k
Appeals and Grievances Specialist II Job Category: Customer... ...to provide health coverage to low-income Los... ...resolution of complaints in compliance with Centers for... ...requirements. This position reviews pre-service... ...weekends, holidays, a hybrid remote schedule, occasional flexibility...Remote workFull timeLocal areaShift workWeekend work
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