State Licensed Appeals Pharmacist

Job Summary

A company is looking for an Appeals Pharmacist.

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
• Document prior authorization and appeals cases thoroughly while maintaining quality and productivity standards

Required Qualifications

• Active, unrestricted pharmacist license
• 1+ years of prior authorization review or appeals experience
• Ability to work independently in a remote, high-volume environment
• Designated secure workplace for remote work
• Proficient in Microsoft Office Suite and clinical resources