Remote Coverage Review Pharmacist

About the job Remote Coverage Review Pharmacist <br> <br>Remote Coverage Review Pharmacist needs 3 years and Doctor of Pharmacy (PharmD) Degree<br><br>Coverage Review Pharmacist requires:<br><ul><li>Clinical experience required, and/or completion of 1 year residency and/or board certification</li><li>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)</li><li>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</li><li>Solid understanding of regulatory guidelines (FDA, NCQA, EQRO, CMS) required</li><li>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</li></ul><br>Coverage Review Pharmacist duties:<br><ul><li>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.</li><li>Performs prospective and retrospective coverage reviews and appeals per State and Federal regulations</li><li> Responds to prescriber, pharmacy provider, member appeals, grievances and complaints related to the provision of pharmaceutical services within established time periods</li><li> Builds and maintains decision trees in the prior authorization system</li><li>Maintains denial rationale associated with clinical criteria and ensures that decision letters meet regulatory compliance</li></ul>