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Job description
Remote Appeals Pharmacist – Fair Medication Access
Work 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 for members — all from home with a schedule that supports better work-life balance.
Key Responsibilities
Review clinical documentation for medication coverage appeals and grievances.
Apply plan policies, evidence-based guidelines, and regulatory requirements to reach determinations.
Prepare clear written clinical rationales supporting appeal outcomes.
Collaborate with physicians, nurses, and medical directors during case reviews.
Track and report appeal outcomes in full compliance with state and federal rules.
Contribute to process improvements that enhance timeliness and quality.
What You'll Bring
Education: PharmD or Bachelor of Pharmacy.
Licensure: Active U.S. pharmacist license.
Experience: Managed care or utilization management preferred. Hospital, ambulatory, and community pharmacists with strong documentation and clinical skills are encouraged to apply.
Skills: Excellent clinical judgment, written communication, and regulatory attention to detail.
Why This Role?
Fully remote or hybrid options available.
Play a critical role in ensuring patients receive fair access to necessary medications.
Build expertise in appeals, utilization management, and managed care.
Competitive salary, comprehensive benefits, and advancement paths.
About Us We are a confidential healthcare partner working with health plans and managed-care organizations nationwide. Our appeals pharmacists protect patient access while upholding regulatory standards. Apply Today Join our team as a Remote Appeals Pharmacist and help ensure every member receives a fair, evidence-based review.
Worksite address
madison, WI, 53774, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.