Appeals Pharmacist - Remote

Overview

The Appeals Pharmacist is responsible for ensuring the accurate and timely review of medication prior authorization appeals. This role involves collaborating with medical professionals, ensuring compliance with clinical criteria, and serving as a source of drug information.

In Short

• Evaluate prior authorization appeals for drug appropriateness per policy criteria.
• Provide excellent customer service to health plan clients, practitioners, and members.
• Serve as an educational resource regarding drug and clinical information.
• Perform case reviews for prior authorization appeals.
• Present cases to appeal decision committee as needed.
• Maintain productivity and quality scores per company standards.
• Train across all queues and lines of business as requested.
• Maintain up-to-date records of case completion.
• Communicate proactively with team and supervisor.
• Participate in company meetings and committees as requested.

Requirements

• Minimum of one year of experience working as a pharmacist.
• Experience with commercial and Medicare Part D appeals preferred.
• Ability to work in a fast-paced environment and manage multiple priorities.
• Strong knowledge of medication, disease states, and medical terminology.
• Strong communication and organizational skills.
• Proficient in Microsoft Word, Excel, OneNote, and PowerPoint.
• Willingness to obtain additional state licensure as required.
• Credentialed and privileged by the company's credentialing committee.

Benefits

• A competitive compensation package.
• Healthcare, vision and dental insurance.
• Generous 401k match.
• Paid vacation, personal time, and holidays.
• Growth and training opportunities.
• A team atmosphere with fun events and prizes.