Remote Coverage Review Pharmacist

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 Originally posted on Himalayas Coverage-Review-Pharmacist, Pharmacist, Pharmacy-Specialist, Clinical-Pharmacist, Prior-Authorization-Pharmacist, Remote-Healthcare-Reviewer, Remote-Clinical-Pharmacist