Licensed Appeals Pharmacist

Job Summary

A company is looking for an Appeals Pharmacist responsible for reviewing clinical coverage determinations and appeals across various lines of business.

Key Responsibilities

• Evaluate and review appeals requests to render coverage determinations based on clinical criteria and medical necessity
• Collaborate with Medical Directors to provide necessary clinical data for clinical reviews
• Make clinical prior authorization determinations in accordance with medical necessity and covered benefit guidelines

Required Qualifications

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