Coverage Review Pharmacist

Pharmacy Coverage Reviews And Appeals

Responsible for various activities associated with coverage reviews and appeals including the review of medication related prior authorizations, pharmacy appeals, and member grievances focused on medications. Performs prospective and retrospective coverage reviews and appeals per State and Federal regulations. Responds to prescriber, pharmacy provider, member appeals, grievances and complaints related to the provision of pharmaceutical services within established time periods. Builds and maintains decision trees in the prior authorization system. Maintains denial rationale associated with clinical criteria and ensures that decision letters meet regulatory compliance.

Top Skills Details PharmD, Medicare Coverage, and / or Prior Authorization Experience

Additional Skills & Qualifications Skills / Certifications - Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability. Experience Level Intermediate Level Setting 100% Remote - MUST reside within 2 hours of Chattanooga, TN Job Type & Location This is a Contract position based out of Chattanooga, TN. Pay and Benefits The pay range for this position is $67.48 / hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following :

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off / Leave (PTO, Vacation or Sick Leave)

Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Dec 1, 2025.

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