Coverage Review Pharmacist

Job Duties & Responsibilities

• Performs prospective and retrospective coverage reviews and appeals per State and Federal regulations.
• Serves as a clinical resource to aid in solving basic to mid-level reviews with limited assistance and supervision.
• Maintains denial rationale associated with clinical criteria and ensures that decision letters meet regulatory compliance and guidance.
• Participates in alternating team on-call rotation.

Job Qualifications

• Education: Doctor of Pharmacy (PharmD) Degree
• Experience: 3 years - Clinical experience required, and/or completion of 1 year residency and/or board certification
• Skills/Certifications: Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability. Competency in compendia navigation and research. Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint). Must be a team player, be organized and able to handle multiple projects. Excellent oral and written communication skills. Strong interpersonal and organizational skills. Solid understanding of regulatory guidelines (FDA, NCQA, EQRO, CMS) required. Knowledge of medical and pharmacy products. License: Licensed in Tennessee to practice Pharmacy, or eligible for licensure in the state of Tennessee to practice Pharmacy within 120 days of employment