Pharmacist, Healthcare

Pharmacist needs 8 years of strong experience in the technical design, development, implementation and support of enterprise solutions.

Doctor of Pharmacy (Pharm

D) 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 Power point)

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

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