Job Description

Job Description

Job Description

Large managed care company is looking for an Pharmacist to perform pharmacy appeals case review for a contract position.

WORK LOCATION: FULLY REMOTE

PAY: $60.00

CONTRACT DATES: 1/13/25 - 6/30/25

HOURS: M-F, 8-5

RESPONSIBILITIES

• Evaluate prescriptions and patient histories
• Interpret physicians' prescriptions and clinical documentation, accesses clinical criteria and compendia support
• Consult with customers, patients and/or physicians regarding use of medications, potential drug interactions, and clinical status for appeals requests
• Conduct Quality Assurance and verify the accuracy of all prescriptions to render appeal decision
• Provide explanations and interpretations within area of expertise
• Review formulary and utilization management guidelines to determine if the drug should be a covered benefit for the beneficiary based on their medical history
• Research, evaluate, and make determinations on member and provider appeals of pharmacy coverage decisions
• Answer questions from support personnel regarding prescription drugs

QUALIFICATIONS

• Active, unrestricted Pharmacist license in your state of residence
• 2+ years of working experience as a licensed Pharmacist
• Experience using online clinical references and accessing professional (clinical and regulatory) internet sites
• Prior authorization/appeals review background
• Excellent written and verbal communication skills
• Experience working with onscreen document images
• Intermediate computer proficiency with MS Office and must have the ability to navigate a Windows based environment

PREFERRED QUALIFICATIONS

• Pharmacy Residency experience
• PBM experience
• Pharm D
• Experience in Medicaid, Commercial (private), and/or Medicare Part D prescription drug plans, programs, or formularies
• Experience in Coverage Determinations (prior authorization) or member appeals
• Pharmacy reimbursement (third party insurance, Medicare Part D formulary management, Medicaid, and Commercial experience

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