Remote Coverage Review Pharmacist Job at Global Channel Management, United States

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  • Global Channel Management
  • United States

Job Description

About the job 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

Job Tags

Work at office

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