Insurance Pharmacist

Job Description

Job Description

Position: Insurance Pharmacist

Openings: 1

Location: Sandy Springs, GA

Pay Rate: $120,000 - $175,000

Must-Haves:

• Doctor of Pharmacy (PharmD) degree from an accredited institution.
• Active GA Pharmacist license in good standing.
• Comfortable working in both strategy and execution
• Experienced beyond “big-box” pharmacy processes
• Capable of building and scaling a multi-state reimbursement program from the ground up

This is a hybrid strategic + hands-on role:

• 60–70%: Payer strategy, insurance contracting, Medicaid/commercial coverage, and reimbursement optimization across multiple states
• 30–40%: Hands-on execution of prior authorizations, appeals, and denial management, while building scalable processes for the team

Target backgrounds:

• PBM or payer-side experience (ideal)
• Independent/specialty/infusion pharmacy with strong reimbursement focus
• Managed care or pharmacy revenue cycle roles

Key responsibilities include:

• Managing and interpreting payer contracts across states (especially Medicaid)
• Developing coverage strategies for compounded medications
• Working directly with plans, PBMs, and Medicaid programs to secure and maintain coverage
• Building playbooks, workflows, and internal systems for claims and approvals
• Troubleshooting complex denials and training the team on best practices