Description: Our client is currently seeking a Fully Remote Coverage Review Pharmacist
This job will have the following responsibilities:
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 period
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
Qualifications & Requirements:
BA/BS degree in Pharmacy or Pharm D
Licensed in Tennessee to practice Pharmacy, or eligible for licensure in the state of Tennessee to practice Pharmacy
3 years - Clinical experience required
Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
Competency in compendia navigation and research
Qualified and interested candidates, please send your most updated resume to
bkehoe@judge.com for immediate consideration, and times you're available for a call to discuss the position.
Thank you and I look forward to speaking with you
Contact: bkehoe@judge.com
This job and many more are available through The Judge Group. Find us on the web at www.judge.com
