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... ...associated with coverage reviews and appeals including the review of medication... ...that decision letters meet regulatory compliance #J-18808-Ljbffr...Remote jobWork at office
- ...Remote Appeals Pharmacist - Fair Medication Access | Work From Home | Strong Clinical Writing... ...fully remote Appeals Pharmacist role. Review medication coverage appeals, apply evidence-based... ...and report appeal outcomes in full compliance with state and federal rules....Remote workWork from home
- WPS Health Solutions is hiring an Appeals Nurse to review medical records and claims for first-level Medicare appeal cases to determine medical necessity and compliance with coverage guidelines. The role collaborates with Appeals Examiners to ensure timely redeterminations...Remote job
- 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
$44 - $79 per hour
...Pharmacist At UnitedHealthcare, we're simplifying the health care... ...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...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
$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 jobHourly payWork experience placement$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- ...Pharmacist, Prior Authorization (PA) & Appeals The pharmacist is responsible for reviewing and evaluating prior authorization and appeals requests to determine coverage based on clinical guidelines, pharmacy policies... ..., and ensure compliance with federal and state...Remote work
- ...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
- ...Description The Pharmacist, Prior Authorization (PA) & Appeals, is responsible for reviewing and evaluating prior... ...requests to determine coverage based on clinical... ...alternatives, 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
- WPS Health Solutions is seeking an Appeals Nurse to review medical records and claims for first-level Medicare redeterminations to determine medical necessity and coverage alignment. You will collaborate with Appeals Examiners/Reps to ensure timely, accurate determinations...Remote job
- ...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
- ...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
- Remote Prior Authorization Pharmacist - Work From Home | Flexible Schedule | High Clinical Impact Transition... ...Prior Authorization Pharmacist role. Review medication requests from home,... ...cost cases. Document all decisions in compliance with CMS, state, and health-plan requirements...Remote jobWork from homeFlexible hoursAfternoon shift
$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- Pharmacy Careers is seeking a Remote DUR Pharmacist to analyze medication use patterns, apply clinical guidelines, and collaborate with providers... ...all from home. This remote role focuses on drug utilization reviews across settings, evaluating prescribing patterns,...Remote job
- ...Remote Clinical Review Pharmacist - Work From Home | Evidence-Based Decisions | Flexible Schedule Leverage your clinical knowledge in a fully remote Clinical Review Pharmacist role. Evaluate prescriptions and treatment plans for safety, appropriateness, and cost...Remote workWork from homeFlexible hours
- Pharmacy Careers is seeking a Remote DUR Pharmacist to analyze medication use patterns from home. You will conduct prospective, concurrent, and retrospective reviews, evaluating prescribing against guidelines and formulary criteria to improve outcomes at scale. The role...Remote job
- WellDyne is seeking a remote Prior Authorization Clinical Pharmacist to handle clinical reviews for PA programs, under the direction of the Manager, Clinical Services. This role focuses on retail clients and adherence to regulatory standards. The candidate should be licensed...Remote job
- Pharmacy Careers is seeking a Remote DUR Pharmacist to analyze medication-use patterns from home, apply clinical guidelines, and... ...interactions, prepare recommendations, and document reviews while ensuring compliance with health-plan requirements. #J-18808-Ljbffr Pharmacy...Remote job
- Pharmacy Careers is seeking a Remote DUR Pharmacist to analyze medication use patterns from home, applying clinical guidelines to... ...conduct prospective, concurrent, and retrospective reviews while ensuring compliance with regulatory standards. Ideal candidates hold a PharmD...Remote job
- Pharmacy Careers is seeking an MTM Pharmacist to positively impact patient... ...comprehensive medication reviews, coaching adherence, and... ..., and ensure CMS MTM program compliance while collaborating with care... ...Bachelor's degrees are welcome; remote or hybrid roles with competitive...Remote jobFlexible hours
- UnitedHealth Group is seeking a Pharmacist to evaluate prescriptions, review clinical data, and render prior authorization decisions. This remote role requires an active state license and strong communication with providers, patients, and internal teams. You will work a...Remote jobMonday to Friday
- Pharmacy Careers in the United States is seeking a Remote DUR Pharmacist to analyze medication use patterns from home. You will apply clinical guidelines, review prescribing against formulary criteria, and collaborate with providers to optimize therapy and reduce risk....Remote job
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