Tennessee Licensed Coverage Review Pharmacist
Job Summary
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)
Complete Job Description
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