Coverage Review Pharmacist

Location: Remote (Must reside within 2 hours of Chattanooga, TN)

Duration: 3-Month Contract (1/18/2027 - 4/16/2027)

Schedule: Monday-Friday, 8:00 AM - 5:00 PM ET (1-hour lunch)

Pay Rate: $67.48/hour

We are seeking a Pharmacist to join a leading Tennessee health insurance provider in a fully remote role. This position is responsible for reviewing medication-related prior authorizations, pharmacy appeals, and member grievances while ensuring compliance with state and federal regulations. The ideal candidate will have prior coverage review experience, strong clinical judgment, and the ability to work independently in a fast-paced environment.

• Review and evaluate medication prior authorization requests, pharmacy appeals, and member grievances.
• Perform prospective and retrospective coverage reviews in accordance with state and federal regulations.
• Respond to prescribers, pharmacy providers, and members regarding appeals, grievances, and pharmaceutical service determinations within established timelines.
• Research and interpret clinical information using pharmaceutical compendia and evidence-based resources.
• Build and maintain decision trees within the prior authorization system.
• Maintain denial rationale documentation and ensure determination letters meet all regulatory requirements.
• Collaborate with internal teams to support quality, compliance, and member service objectives.
• Apply clinical criteria and guidelines to make appropriate coverage determinations.

• Licensed to practice Pharmacy in Tennessee, or eligible for Tennessee licensure.
• Minimum of 3 years of clinical pharmacy experience
  , or completion of a 1-year residency and/or board certification
  .
• Prior coverage review experience required.
• Strong understanding of pharmacy prior authorizations, appeals, and utilization management processes.
• Ability to work independently with minimal supervision and effectively within a team environment.
• Experience navigating pharmaceutical compendia and conducting clinical research.
• Proficiency with Microsoft Office applications, including Outlook, Word, and Excel.

• 100% Remote
• Monday-Friday schedule, no weekends
• Opportunity to work with a prominent Tennessee-based health insurance organization
• Gain experience in managed care and pharmacy coverage review
• Competitive pay at $67.48/hour

Work Environment: Home-based role. Candidates must reside within 2 hours of Chattanooga, TN
.

This is a Contract position based out of Chattanooga, TN.

The pay range for this position is $67.48 - $67.48/hr.

Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may besubject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical
• dental & vision
  
  Critical Illness
• Accident
• and Hospital
  401(k) Retirement Plan Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

This is a Contract position based out of Chattanooga, TN.

This position is anticipated to close on Nov 24, 2026.

This is a fully remote position.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability,sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability,please email actalentaccom for other accommodation options.

San Francisco Fair Chance Ordinance:Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in thecity and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts…