Coverage Review Pharmacist Coverage Review Pharmacist - Contract

Job Title: Coverage Review Pharmacist Location: Remote Duration: 06 Months Shift time-8-5 PM, M-F Description: Responsible for various activities associated with coverage reviews and appeals including the review of medication related prior authorizations, pharmacy appeals, and member grievances focused on medications. 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 l l Builds and maintains decision trees in the prior authorization system l Maintains denial rationale associated with clinical criteria and ensures that decision letters meet regulatory compliance Quals-- All applicants will be advised that Client, as a federal contractor, may be required to implement a COVID-19 vaccine mandate. Education l Doctor of Pharmacy (PharmD) Degree Experience 3 years - Clinical experience required, and/or completion of 1 year residency and/or board certification SkillsCertifications Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability. 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 to practice Pharmacy #TB_PH Remote Skills: Communication Skills, Content Management Systems (CMS), Contract Review, External Quality Review Organization (EQRO), FDA Requirements, Federal Contracts, Federal Laws and Regulations, Interpersonal Skills, Medical Products, Medications, Microsoft Excel, Microsoft Office, Microsoft Outlook, Microsoft PowerPoint, Microsoft Word, Multitasking, National Committee for Quality Assurance (NCQA), Organizational Skills, Pharmacy, Presentation/Verbal Skills, Regulatory Compliance, State Laws and Regulations, Team Player About the Company: TalentBurst, Inc. For over 20 years, TalentBurst Inc. has been an award-winning provider of cutting-edge Workforce Management Solutions. With a strong commitment to staying ahead in the tech landscape, we pioneer innovative approaches to talent acquisition. Our expertise spans Life Sciences, and Healthcare Staffing, Banking, Financial, IT, and Engineering, as well as Global Employer of Record (EOR), Agent of Record (AOR), State, Local Government and Education (SLED), and IC validation/compliance services. Additionally, our division, TalentProcure, leads the industry with offerings such as High Hazard Payroll, Managed Services, and Vendor on Premise (VOP) solutions. Due to our prioritization of excellent standards, we are Joint Commission Certified and are a certified Minority Business Enterprise (MBE) in the USA and Canada. Supporting over 130 Fortune 500 companies globally, we excel in navigating the landscape of talent acquisition. In a world of constant change, we embrace developing people-centric solutions that address the unique demands of our clients. Stay connected by visiting our website and following us on social media! Company Size: 5,000 to 9,999 employees Industry: Staffing/Employment Agencies Founded: 2002 Website: Apply tot his job