Appeals Pharmacist (Remote) Job at Pharmacy Careers, Silver Spring, MD

  • Pharmacy Careers
  • Silver Spring, MD

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

  1. Review clinical documentation for medication coverage appeals and grievances.
  2. Apply plan policies, evidence-based guidelines, and regulatory requirements to reach determinations.
  3. Prepare clear written clinical rationales supporting appeal outcomes.
  4. Collaborate with physicians, nurses, and medical directors during case reviews.
  5. Track and report appeal outcomes in full compliance with state and federal rules.
  6. 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.

Job Tags

Work from home

Similar Jobs

Intermountain Health

Echocardiographic Technician Job at Intermountain Health

 ...Job Description: The Echo Tech performs a variety of diagnostic cardiac exams under the direction of a physician for identification of abnormalities leading to patient diagnosis. Posting Specifics Shift Details: Full-time (40 hours/week), four 10-hour shifts... 

Cragun

Golf Player Assistant Job at Cragun

 ...customer service is a plus, but not required.Must be available to work flexible hours, including weekends and holidaysMust have a valid Driver's LicenseEmployee Benefits:Incredible Cragun's Resort Discounts (marina rentals, recreation, pools, beaches, etc.)Dining... 

Hawaii Medical Institute Inc

Nurse Aide Instructor with RN License Job at Hawaii Medical Institute Inc

 ...adult education settings - Experience working with senior care or in critical care...  ...: 1 year (Required) License/Certification: RN (Required) CNA (Preferred) Work Location: Hybrid remote in Honolulu, HI 96814 Flexible work from home options available.... 

The Coffee Tree Roasters

Barista - Coffee Tree Roasters Job at The Coffee Tree Roasters

 .../ordering counter station, as well as a drive-thru station. Coffee shops are a third space for the community build relationships...  ...drinks in accordance with health code guidelines and Coffee Tree Roasters standards (such as dialing-in espresso, following ratios for... 

Kainos

Workday EDM Solution Consultant - Manager Job at Kainos

 ...ambitious team that celebrates creativity and collaboration.Ready to make your mark? Join us and be part of something bigger.Workday EDM Solution ConsultantAs a Solution Consultant for Kainos Employee Document Management (EDM), you will play a critical role in driving new...