Licensed Appeals Pharmacist

Job Summary

To support efficient clinical decision-making, the remote, temp-to-hire Licensed Appeals Pharmacist will review clinical coverage determinations and appeals for various business lines, collaborating with healthcare providers and internal Medical Directors to ensure quality and timely responses.

Key responsibilities:

• Evaluate and review appeals requests to make coverage determinations based on clinical criteria and medical necessity
• Collaborate with Medical Directors and provide necessary clinical data for reviews per health plan criteria
• Maintain quality and productivity standards while adhering to established turnaround times for all cases reviewed

Required qualifications:

• Active, unrestricted pharmacist license required
• 1+ years of prior authorization review or appeals experience required
• Ability to work independently in a remote, high-volume environment with shifting priorities
• Designated secure workplace for remote work during business hours
• Proficient in Microsoft Office Suite and clinical resources (e.g., Micromedex, Lexicomp)