Appeals Clinical Specialist (Pharmacy)

Location: San Diego, California, United States; primarily on-site at the San Diego headquarters or another company location, with remote work possible only with management approval.

Salary: $52.17–$73.30–$94.43 per hour.

Company

hirify.global is a privately held pharmacy benefit manager providing pharmaceutical and technology solutions to improve healthcare outcomes, cost, transparency, and access.

What you will do

• Conduct independent clinical reviews of appeal requests, including analysis, recommendations, determinations, and documentation.
• Evaluate medical records and medication request guidelines for clinical appropriateness and operational efficiency.
• Research clinical literature and provide drug information supporting prior authorization decisions, formulary reviews, and Pharmacy and Therapeutics materials.
• Coordinate utilization and compliance reporting, including plan data reviews and client presentations.
• Support appeal program development, implementation, communications, and cross-departmental projects.
• Provide clinical feedback to Prior Authorization and Appeals and Grievances teams.

Requirements

• PharmD and at least 3 years of experience, or an equivalent combination of education and experience, plus 1 year of subject-matter expertise in the relevant area.
• Current, unrestricted Registered Pharmacist license in good standing in any U.S. state.
• Ability to obtain Kentucky licensure within three months of hire.
• Strong knowledge of pharmacy services, particularly in managed healthcare, and expertise in the clinical application of pharmacy practice.
• Strong Microsoft Office and Outlook skills, with familiarity with databases and internet research.
• Excellent written, verbal, presentation, active listening, problem-solving, and customer-service skills.

Culture & Benefits

• Collaborative, high-performance environment focused on improving healthcare value.
• Medical, dental, vision, and wellness programs.
• Paid time off, company-paid holidays, life and disability insurance.
• 401(k) with company match, incentive compensation, and employee referral bonus.
• Tuition reimbursement.
• Typical hours are Monday through Friday, 8:00 a.m. to 5:00 p.m.; occasional overtime, night, weekend, or holiday work may be required.