Coverage Review Pharmacist
The Judge Group Inc.

Job Info

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Location: REMOTE
Salary: $50.00 USD Hourly - $58.00 USD Hourly
Description: Our client is currently seeking a Fully Remote Coverage Review Pharmacist

This job will have the following responsibilities:

• 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 period
• 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

Qualifications & Requirements:

• BA/BS degree in Pharmacy or Pharm D
• Licensed in Tennessee to practice Pharmacy, or eligible for licensure in the state of Tennessee to practice Pharmacy
• 3 years - Clinical experience required
• Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
• Competency in compendia navigation and research

Qualified and interested candidates, please send your most updated resume to

bkehoe@judge.com for immediate consideration, and times you're available for a call to discuss the position.

Thank you and I look forward to speaking with you

Contact: bkehoe@judge.com

This job and many more are available through The Judge Group. Find us on the web at www.judge.com

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