Tennessee Licensed Coverage Review Pharmacist

Job Summary

To support its clinical operations team, the full-time Tennessee Licensed Coverage Review Pharmacist will perform prospective and retrospective coverage reviews, including prior authorizations and appeals, while working remotely and independently to ensure compliance with regulatory standards.

Key responsibilities

• Perform prospective and retrospective coverage reviews and appeals in accordance with state and federal regulations
• Serve as a clinical resource to assist in resolving basic to mid-level reviews with limited supervision
• Maintain denial rationale related to clinical criteria and ensure compliance with regulatory guidance in decision letters

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
• Solid understanding of regulatory guidelines (FDA, NCQA, EQRO, CMS)
• Experience with NovoLogix or MHK systems is preferred