Remote Coverage Review Pharmacist

Overview

The Remote Coverage Review Pharmacist is responsible for managing coverage reviews and appeals related to medication, ensuring compliance with regulatory standards.

In Short

• Requires 3 years of experience and a Doctor of Pharmacy (PharmD) degree.
• Clinical experience or completion of a residency is preferred.
• Ability to work independently or as part of a team.
• Proficient in Microsoft Office applications.
• Strong communication and organizational skills are essential.
• Knowledge of regulatory guidelines (FDA, NCQA, EQRO, CMS) is required.
• Responsible for reviewing medication-related prior authorizations and appeals.
• Must maintain compliance with state and federal regulations.
• Builds and maintains decision trees in the prior authorization system.
• License required to practice pharmacy in Tennessee.

Requirements

• Doctor of Pharmacy (PharmD) degree.
• 3 years of clinical experience or completion of a residency.
• Proficient in Microsoft Office (Outlook, Word, Excel, PowerPoint).
• Strong oral and written communication skills.
• Ability to handle multiple projects effectively.
• Solid understanding of regulatory guidelines.
• Licensed or eligible for licensure in Tennessee.

Benefits

• Remote work flexibility.
• Opportunity to work in a dynamic healthcare environment.
• Collaborative team atmosphere.
• Professional development opportunities.
• Competitive salary and benefits package.