Remote Appeals Pharmacist

Position Overview

Join a mission-driven healthcare team as a Remote Appeals Pharmacist, where your clinical knowledge directly supports patients in accessing the treatments they need. This role enables you to make meaningful contributions to resolving medication access challenges from the convenience and comfort of your own home. With a strong focus on accuracy, timeliness, and collaborative communication, you will work at the intersection of clinical judgment and insurance navigation.

This position offers an annual salary of $126,701 and the opportunity to work in a supportive, forward-thinking environment that values integrity and innovation.

Key Responsibilities

• Review and process prior authorization appeals for medications, ensuring adherence to current clinical guidelines and benefit plans.
• Analyze medical necessity documentation submitted by providers and ensure it aligns with applicable drug utilization policies.
• Draft clinical appeal letters and rationales using evidence-based literature and current formulary references.
• Collaborate with cross-functional teams, including other pharmacists, clinical reviewers, and claims specialists, to ensure accurate case resolution.
• Maintain compliance with federal, state, and health plan-specific regulations and privacy laws.
• Provide timely feedback to internal and external stakeholders regarding appeal outcomes and procedural updates.
• Utilize pharmacy and medical benefit platforms to gather, verify, and interpret prescription and medical histories.
• Identify trends in denials or delays and contribute insights to improve internal processes and educational resources.

Required Skills and Qualifications

• Current authorization to practice pharmacy in one or more U.S. states without restrictions.
• At least two years of prior experience handling pharmacy appeals, utilization reviews, or prior authorizations.
• Solid knowledge of pharmaceutical care standards, treatment protocols, and coverage policies.
• Meticulous attention to detail and strong analytical thinking when reviewing clinical records.
• Skilled in understanding medical codes and healthcare terminology, such as ICD-10 and CPT.
• Experience with prescription and health plan systems, including EMRs and claims databases.
• Clear and effective written and spoken communication abilities.
• Ability to navigate complex workflows while meeting tight deadlines.

Work Environment

• 100% remote work opportunity with secure technology infrastructure.
• Flexible scheduling aligned with case volume and turnaround requirements.
• Virtual collaboration through secure communication platforms.
• Supportive team culture with routine check-ins and team-building activities.

This position is ideal for individuals who are self-motivated, adaptable to change, and passionate about patient advocacy through the lens of pharmaceutical care.

Tools and Technology

• Pharmacy Benefit Management (PBM) platforms
• Electronic Medical Record (EMR) systems
• Claims adjudication tools
• Secure messaging and teleconferencing software
• Cloud-based case management systems

Candidates should feel comfortable using data analysis tools to evaluate trends in appeal submissions and resolutions. Familiarity with e-prescribing applications and medication database platforms is highly advantageous.

Growth Opportunities

This role offers a unique pathway to influence how healthcare access decisions are made. Team members can look forward to:

• Expanding their expertise in managed care pharmacy
• Participating in policy development initiatives
• Taking part in professional certification programs
• Advancing into clinical lead or training roles within the organization

Our team places a high value on knowledge sharing and mentorship, ensuring a well-supported journey for every pharmacist.

What Makes This Role Meaningful

Your work as an Appeals Pharmacist directly contributes to eliminating barriers to care. Each case you manage is an opportunity to advocate for patients and ensure they receive clinically appropriate treatment. By integrating your clinical expertise with regulatory knowledge, you'll be a pivotal part of a patient-centric appeals process that emphasizes fairness, transparency, and quality.

Benefits and Compensation

• Competitive salary: $126,701 annually
• Generous paid time off and holidays
• Health, dental, and vision coverage
• 401(k) plan with company match
• Continuing education reimbursement
• Technology allowance for remote setup

These benefits are designed to support your well-being and professional development in a fully remote work model.

Who You’ll Work With

You’ll be part of a collaborative network of pharmacists, appeals specialists, and clinical reviewers committed to driving equitable access to medication. Our organization fosters a culture that is:

• Solution-oriented
• Patient-first
• Transparent and inclusive
• Empowered by technology

Our leadership believes in open communication, regular feedback, and team wins. Your voice and contributions will always matter.

Ready to Apply?

Suppose you’re a licensed pharmacist with experience in utilization review, passionate about ensuring fair access to care, and looking for a role where your decisions truly make a difference. In that case, we’d love to meet you.

Apply today and help us redefine the future of pharmacy-driven patient advocacy.