Tennessee Licensed Coverage Review Pharmacist

Job Summary

A company is looking for a Coverage Review Pharmacist to perform coverage reviews and ensure compliance with regulatory standards.

Key Responsibilities

• Perform prospective and retrospective coverage reviews and appeals in accordance with state and federal regulations
• Act as a clinical resource for basic to mid-level reviews with limited supervision
• Maintain denial rationales and ensure compliance of decision letters with regulatory guidelines

Required Qualifications

• Doctor of Pharmacy (PharmD) Degree
• 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
• Solid understanding of regulatory guidelines (FDA, NCQA, EQRO, CMS)
• Competency in compendia navigation and research