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Remote Coverage Review Pharmacist
Remote Coverage Review PharmacistGlobalchannelmanagement • Chattanooga, Tennessee, USA
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Remote Coverage Review Pharmacist

Remote Coverage Review Pharmacist

Globalchannelmanagement • Chattanooga, Tennessee, USA
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Remote Coverage Review Pharmacist needs 3 years and Doctor of Pharmacy (PharmD) Degree

Coverage Review Pharmacist requires :

  • Clinical experience required and / or completion of 1 year residency and / or board certification
  • 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 have the ability to handle multiple projects Excellent oral and 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

Coverage Review Pharmacist duties :

  • 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
  • Key Skills

    LTC Pharmacy,Hospital Experience,Pharmacy Software,Continuous Improvement,Go,Infusion Experience,Pharmacy Residency,Training & Development,Order Entry,Epic,Clinical Pharmacy Experience,Compounding Medications

    Employment Type : Full Time

    Experience : years

    Vacancy : 1

    Hourly Salary Salary : 65 - 67

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    Pharmacist • Chattanooga, Tennessee, USA

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