Remote Pharmacist Reviewer – Clinical Coding & Claims

About the role

We are seeking a licensed U.S. pharmacist to work remotely as a Pharmacist Reviewer, focusing on clinical coding and claims verification. The role involves evaluating medication requests, ensuring compliance with formulary guidelines, and supporting managed‑care processes.

Key responsibilities

• Review and authorize medication claims and prior‑authorization requests.
• Perform clinical coding and assess formulary versus non‑formulary cases.
• Research drug usage, exceptions, and payer guidelines to support decision‑making.
• Utilize multiple healthcare IT systems to document findings and communicate outcomes.
• Collaborate with clinical and payer teams to resolve complex cases.

Required profile

• Active U.S. pharmacist license.
• Minimum 5 years of pharmacy experience, including at least 3 years in a hospital setting.
• Strong background in managed care, clinical coding, and claims review.
• Proven ability to conduct detailed drug research and evaluate exceptions.

Required skills

• Clinical coding
• Claims review
• Managed‑care processes
• Drug research and utilization management
• Proficiency with multiple healthcare IT systems

What we offer

• 100 % remote work arrangement.
• Contract position with flexible scheduling.
• Opportunity to apply clinical expertise in a dynamic, technology‑driven environment.