To support clinical operations, the full-time Tennessee Licensed Coverage Review Pharmacist will perform prospective and retrospective coverage reviews and appeals while serving as a clinical resource in a remote environment. Key responsibilities Conducts coverage reviews and appeals in compliance with State and Federal regulations Maintains denial rationale and ensures decision letters adhere to regulatory standards Participates in team on-call rotation to provide support as needed Required qualifications Doctor of Pharmacy (PharmD) Degree Minimum of 3 years of clinical experience or completion of a 1-year residency and/or board certification Licensed in Tennessee to practice Pharmacy or eligible for licensure within 120 days of employment Strong understanding of regulatory guidelines (FDA, NCQA, EQRO, CMS) Proficiency in Microsoft Office applications (Outlook, Word, Excel, PowerPoint)
Tennessee Licensed Coverage Review Pharmacist in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.