Coverage Review Pharmacist
The Judge Group Inc.

Miami, Florida

Posted in IT


Job Info


Location: REMOTE
Salary: $50.00 USD Hourly - $58.00 USD Hourly
Description: Our client is currently seeking a Fully Remote Coverage Review Pharmacist

This job will have the following responsibilities:

  • 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 period
  • 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

Qualifications & Requirements:
  • BA/BS degree in Pharmacy or Pharm D
  • Licensed in Tennessee to practice Pharmacy, or eligible for licensure in the state of Tennessee to practice Pharmacy
  • 3 years - Clinical experience required
  • Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
  • Competency in compendia navigation and research

Qualified and interested candidates, please send your most updated resume to

bkehoe@judge.com for immediate consideration, and times you're available for a call to discuss the position.

Thank you and I look forward to speaking with you
Contact: bkehoe@judge.com

This job and many more are available through The Judge Group. Find us on the web at www.judge.com



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