Manager Pharmacist, Pharmacy Appeals - Remote

Overview

The Manager Pharmacist, Pharmacy Appeals is responsible for overseeing the appeal process related to pharmacy claims, ensuring compliance with state regulations, and leading a team to resolve complex issues efficiently.

In Short

• Manage the Pricing Department of Insurance (DOI) team.
• Review and resolve MAC appeals.
• Lead and guide the appeals team in compliance matters.
• Collaborate with legal and compliance teams on pharmacy complaints.
• Provide training and mentorship to team members.
• Monitor compliance and create necessary reports.
• Develop solutions for complex pharmacy bill compliance.
• Ensure effective response to state DOI inquiries.
• Conduct audits and maintain quality control processes.
• Drive profitability through pricing solutions.

Requirements

• 5+ years of experience in pharmacy appeals and claims adjudication.
• 3+ years of leadership experience.
• Excellent communication and organizational skills.
• Proficiency in Excel, MS Access, and Salesforce.
• Bachelor's or Pharm D degree in Pharmacy.
• Current Pharmacist License in good standing.

Benefits

• Comprehensive medical plan options.
• 401(k) plan with company match.
• Employee stock purchase plan.
• Wellness programs and counseling services.
• Flexible work schedules and paid time off.
• Tuition assistance and retiree medical access.