Coverage Review Pharmacist

Description

• 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

Top Skills Details

PharmD, Medicare Coverage, and / or Prior Authorization Experience

Additional Skills & Qualifications

Skills\Certifications - Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.

Experience Level

Intermediate Level

Setting

100% Remote - MUST reside within 2 hours of Chattanooga, TN

Job Type & Location

This is a Contract position based out of Chattanooga, TN.

Pay and Benefits

The pay range for this position is $67.48 - $67.48 / hr.

Eligibility requirements apply to some benefits and may depend on your job

classification and length of employment. Benefits are subject to change and may be

subject to specific elections, plan, or program terms. If eligible, the benefits

available for this temporary role may include the following :

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on Dec 1, 2025.