Pharmacist needs 8 years of strong experience in the technical design, development, implementation and support of enterprise solutions.
Pharmacist requires:
COVID-19 vaccine mandate.
Doctor of Pharmacy (PharmD) Degree
3 years - Clinical experience required, and preference for coverage review experience.
Competency in compendia navigation and research Proficient in Microsoft Office (Outlook, Word, Excel and Powerpoint)
Must be a team player, be organized and have the ability to handle multiple projects Excellent oral and communication skills
Strong interpersonal and organizational skills
Solid understanding of regulatory guidelines (FDA, NCQA, EQRO, CMS) required
Knowledge of medical and pharmacy products License
Licensed in Tennessee to practice Pharmacy, or eligible for licensure in the state of Tennessee
Pharmacist duties:
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 periods
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