Appeals Pharmacist (Remote) Job at Pharmacy Careers, Milwaukee, WI

WVVuV0Nqa3gvNmRZQTByQk9wVHl6dDZxa1E9PQ==
  • Pharmacy Careers
  • Milwaukee, WI

Job Description

Appeals Pharmacist – Ensure Fair Medication Access for Patients

A confidential managed care organization is seeking an experienced Appeals Pharmacist to review, evaluate, and process medication coverage appeals. This role is ideal for pharmacists who want to leverage their clinical knowledge and critical thinking skills to advocate for patients and ensure fair, evidence-based decisions.

Key Responsibilities
  • Review clinical documentation for medication coverage appeals and grievances.
  • Apply evidence-based guidelines, plan policies, and regulatory requirements to determine outcomes.
  • Prepare written clinical rationales to support appeal determinations.
  • Collaborate with physicians, nurses, and medical directors during case reviews.
  • Track, document, and report appeal outcomes in compliance with state and federal regulations.
  • Support process improvements to enhance timeliness and quality of appeal decisions.


What You’ll Bring

  • Education: Doctor of Pharmacy (PharmD) or Bachelor of Pharmacy degree.
  • Licensure: Active and unrestricted pharmacist license in the U.S.
  • Experience: Prior managed care or utilization management experience preferred — retail and hospital pharmacists with strong clinical and documentation skills are encouraged to apply.
  • Skills: Excellent clinical judgment, written communication, and attention to regulatory detail.


Why This Role?

  • Impact: Play a critical role in ensuring patients get fair access to necessary medications.
  • Growth: Gain expertise in appeals, utilization management, and managed care pharmacy.
  • Flexibility: Many roles offer hybrid or fully remote options.
  • Rewards: Competitive salary, comprehensive benefits, and opportunities for advancement.


About Us
We are a confidential healthcare partner working with health plans and managed care organizations nationwide. Our appeals pharmacists safeguard patient access while ensuring compliance with all regulatory standards.

Apply Today
Join our team as an Appeals Pharmacist and help ensure every patient receives a fair review of their medication needs.

Job Tags

Similar Jobs

Gainwell Technologies LLC

Healthcare Project Manager Job at Gainwell Technologies LLC

 ...Creates and implements complex project definitions, schedules,...  ...contact with client project management. Identifies, when and as appropriate...  ...expect in this role Remote position (US only) Opportunities...  ...who care deeply about making healthcare work better for everyone.... 

Tapestry

Shipping Clerk Job at Tapestry

 ...Clerk in West Chester, OH, responsible for coordinating shipping activities and maintaining accurate shipment records. The role requires strong organizational skills and proficiency in shipping software. A high school diploma and prior experience in logistics are preferred.

Blue Sky Plumbing & Heating

Plumbing Service Technician Job at Blue Sky Plumbing & Heating

 ...Blue Sky Plumbing, Heating, Cooling & Electric is a 4th generation family-owned business that believes our company is only as strong as our reputation. We believe our greatest strength is our team members and caring for them the same as family is what separates us from... 

Minute Men Staffing

Pre-Sewing Machine Operator 2nd Shift Job at Minute Men Staffing

 ...Now hiring Pre-Sewing Machine Operators in Cleveland for 2 nd shift, 3pm 1am. Monday Thursday. Weekly pay at $16.45 per hour. Job Description: Operate pre-sewing equipment to prepare materials for the sewing process. Measure, cut, and align fabric... 

Goodcents

Crew Member - 842 Bryan Road Job at Goodcents

 ...Now hiring Crew Membersat our Goodcents location at842 Bryan Rd in O'Fallon, MO. Special preference to daytime availability! Starting wages range from 11.15-$14 per hour based on experience and availability. Star performershave a fast-track for promotion to...