Dear Partner,
Good Morning ,
Greetings from Nukasani group Inc !, We have below urgent long term contract project immediately available for Coverage Review Pharmacist, Chattanooga, TN need submissions you please review the below role, if you are available, could you please send me updated word resume, and below candidate submission format details, immediately. If you are not available, any referrals would be greatly appreciated.
Interviews are in progress, urgent response is appreciated. Looking forward for your immediate response and working with you.
**Candidate Submission Format - needed from you**
Full Legal Name
Personal Cell No ( Not google phone number)
Email Id
Skype Id
Interview Availability
Availability to start, if selected
Current Location
Open to Relocate
Work Authorization
Total Relevant Experience
Education./ Year of graduation
University Name, Location
Last 4 digits of SSN
Country of Birth
Contractor Type
: mm/dd
Home Zip Code
**Assigned Job Details **
Job Title :Coverage Review Pharmacist
Location: Chattanooga, TN
Rate : Best competitive rate On w2
**Position Overview**
We are seeking an experienced and detail-oriented Coverage Review Pharmacist to join our team in Chattanooga, Tennessee. This role is responsible for conducting pharmacy coverage reviews, prior authorizations, and appeals in accordance with state and federal regulations.
The ideal candidate will have strong clinical experience, a deep understanding of pharmacy and medical products, and the ability to interpret and apply regulatory guidelines (FDA, NCQA, EQRO, CMS). This position requires excellent communication skills, critical thinking, and the ability to work both independently and collaboratively in a fast-paced environment.
**Key Responsibilities**
Conduct prospective and retrospective coverage reviews and appeals in compliance with state and federal regulations.
Review and evaluate medication-related prior authorizations, pharmacy appeals, and member grievances.
Respond to inquiries and appeals from prescribers, pharmacy providers, and members within established timelines.
Develop and maintain clinical decision trees and denial rationales within the prior authorization system.
Ensure all decision letters and communications meet regulatory and compliance standards.
Collaborate with internal teams to support consistency, accuracy, and efficiency in clinical review processes.
**Qualifications**
Education:
Doctor of Pharmacy (PharmD) degree required.
Experience:
Minimum of 3 years of clinical experience, or completion of a 1-year pharmacy residency, or board certification.
Licensure:
Must be licensed (or eligible for licensure) to practice pharmacy in the state of Tennessee.
**Skills & Competencies:**
Strong clinical knowledge of medical and pharmacy products.
Competency in compendia navigation and clinical research.
Proficient in Microsoft Office Suite (Outlook, Word, Excel, PowerPoint).
Excellent written and verbal communication skills.
Strong organizational, analytical, and problem-solving abilities.
Ability to manage multiple projects and meet deadlines in a dynamic environment.
Effective team player with the ability to work independently under minimal supervision.
Thorough understanding of relevant regulatory guidelines, including FDA, NCQA, EQRO, and CMS.
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Nancy
Talent Acquisition | Nukasani Group Inc
Tel
Email:
540 W Galena Blvd, Suite 200, Aurora IL 60506.
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