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Open nowFirst seen 4 days ago

Remote Coverage Review Pharmacist

Globalchannelmanagement685 open roles

Where
Chattanooga, Tennessee, United States
Work mode
Remote
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Your applicationOpen nowRemote Coverage Review PharmacistGlobalchannelmanagement · Chattanooga, Tennessee, United States

  1. YouYes, apply to this one.

  2. CV RocketCV written for this posting.

  3. 25 readersRecruiter, hiring manager, skeptic. Round after round.

  4. CV RocketApplied on Globalchannelmanagement's own form.

The reply lands in your private mailbox

3×more interviews than doing it yourself with ChatGPT.

The clock on this job

Early applications get read.

12.3% of postings close within 7 days. Measured by our own scanner across the market.

Share of postings closed within
  1. 2.1%1 day
  2. 4.5%3 days
  3. 12.3%7 days
  4. 19.3%14 days
  5. 35.6%30 days
  6. 57.8%60 days
This job: first seen 4 days ago

The posting

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
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