Appeals Pharmacist

Position Summary:

• Responsible for reviewing clinical coverage determination and appeals for different lines of business.
• Knowledgeable in all aspects of coverage determination and appeals process.
• Assist in meeting client expectations regarding efficiency and quality decision making.

Position Responsibilities:

• Performs and handles inbound and outbound phone calls with physicians, healthcare providers and/or patients to facilitate appeal requests.
• Collaborate with internal and external Medical Directors by providing appropriate clinical/medical data needed to perform clinical reviews per the health plan criteria.
• Provide detailed and thorough documentation in prior authorization cases, appeals cases, and overrides.

Minimum Qualifications:

• Active, unrestricted, pharmacist license required
• 1+ years prior authorization review or appeals experience required.
• Ability to work independently with minimal supervision.