North Carolina Licensed Appeals Pharmacist

Job Summary

Supervising a team of appeal pharmacists, the full-time salaried North Carolina Licensed Appeals Pharmacist will oversee prior authorization processes, manage compliance risks, and provide training while working remotely.

Key responsibilities

• Supervise appeal pharmacists and technicians, ensuring compliance with prior authorization operations
• Analyze data to recommend staffing and workflow enhancements for prior authorization processes
• Conduct clinical pharmacy functions including prior authorization and appeal reviews, and manage escalated issues

Required qualifications

• Doctor of Pharmacy (Pharm.D.) or Bachelor of Pharmacy degree from an accredited program
• Active unrestrictive pharmacist license
• 2 years of experience as a clinical pharmacist in a Pharmacy Benefit Management (PBM) setting
• 1+ year of experience with Commercial and/or Medicare appeals
• Strong understanding of pharmacy benefit management processes, including claims processing and prior authorization