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Job Requirements of Coverage Review Pharmacist:
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Employment Type:
Contractor
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Location:
Chattanooga, TN (Onsite)
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Coverage Review Pharmacist
Job Title: Pharmacist – Coverage Reviews and Appeals
Duration: 5 Months
Location: Tennessee (Licensed or Eligible for Licensure)
Type: Contract
Job Summary:
Responsible for activities related to coverage reviews and appeals, including the review of medication-related prior authorizations, pharmacy appeals, and member grievances focused on medications.
Key Responsibilities:
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Perform prospective and retrospective coverage reviews and appeals in accordance with State and Federal regulations.
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Respond to prescriber, pharmacy provider, and member inquiries, appeals, grievances, and complaints regarding pharmaceutical services within established timelines.
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Build and maintain decision trees in the prior authorization system.
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Maintain denial rationales aligned with clinical criteria and ensure that decision letters comply with regulatory requirements.
Education:
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Doctor of Pharmacy (PharmD) degree required.
Experience:
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Minimum 3 years of clinical experience, or completion of a 1-year residency and/or board certification.
Skills & Certifications:
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Ability to work independently with minimal supervision, as well as collaboratively in a team environment.
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Proficient in Microsoft Office (Outlook, Word, Excel, PowerPoint).
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Competent in compendia navigation and research.
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Strong organizational, interpersonal, and communication skills.
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Ability to manage multiple projects effectively.
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Solid understanding of regulatory guidelines (FDA, NCQA, EQRO, CMS).
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Knowledge of medical and pharmacy products.
License:
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Must be licensed in Tennessee to practice Pharmacy, or eligible for licensure in the state of Tennessee.