Supervisor, Appeals Pharmacist - Remote

Overview

The Supervisor, Appeals Pharmacist acts as a subject matter expert on prior authorization and appeals operations, ensuring compliance with regulatory standards while overseeing the prior authorization processes and managing a team of pharmacists.

In Short

• Supervise a team of appeal pharmacists and technicians.
• Oversee appeal job aids and clinical denial language.
• Analyze data to recommend staffing and workflow enhancements.
• Provide ongoing training for staff and onboarding for new pharmacists.
• Resolve escalated issues from clients and providers.
• Collaborate with Medicare supervisor for staffing and workflow processes.
• Perform clinical pharmacy functions including prior authorization reviews.
• Make clinical decisions based on medical necessity and contract criteria.
• Evaluate scientific literature to support provider recommendations.
• Communicate effectively with providers and members for positive health outcomes.

Requirements

• Doctor of Pharmacy (Pharm.D.) or Bachelor of Pharmacy degree.
• Active unrestrictive pharmacist license.
• 2 years of clinical pharmacist experience in a PBM setting.
• 1+ year of experience with Commercial and/or Medicare appeals.
• Strong understanding of pharmacy benefit management processes.
• Excellent analytical skills for complex pharmacy claims analysis.
• Strong leadership skills for team management.
• Proficient in Microsoft Office Suite.
• Ability to work flexible hours including on-call rotations.

Benefits

• Flexible position description to meet organizational goals.
• Opportunity to work in a diverse workplace.
• Equal employment opportunities provided.
• Comprehensive health benefits.
• Professional development opportunities.