Nukasani Group Inc
Naperville, IL
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Job Description :

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, Onsite 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, Onsite
Rate : Best competitive rate

Position Overview

We are seeking an experienced Coverage Review Pharmacist to join our healthcare team supporting BlueCross BlueShield of Tennessee (BCBST). The ideal candidate will bring strong clinical expertise in Medicare Coverage and Prior Authorization processes, along with a solid understanding of state and federal regulations. This role is part of a collaborative six-member team dedicated to ensuring compliant and accurate medication coverage decisions.

Interviews will be conducted via Microsoft Teams (two rounds). Candidates licensed in Tennessee are preferred but not required.

Key Responsibilities

  • Conduct coverage reviews and appeals for medication-related prior authorizations, pharmacy appeals, and member grievances.

  • Perform both prospective and retrospective reviews in compliance with state and federal regulations.

  • Respond to inquiries from prescribers, pharmacies, and members regarding pharmaceutical coverage decisions within established timelines.

  • Build and maintain decision trees within the prior authorization system.

  • Maintain and update denial rationale and ensure all decision letters meet regulatory and compliance requirements.

  • Collaborate with cross-functional teams to ensure consistency and accuracy in coverage determination processes.

Note: This position does not involve outbound calls to verify coverage.

Qualifications

Education:

  • Doctor of Pharmacy (PharmD) degree required.

Experience:

  • Minimum of 3 years of clinical pharmacy experience, OR

  • Completion of a 1-year residency and/or relevant board certification.

Licensure:

  • Active license to practice Pharmacy in the state of Tennessee, or eligibility for licensure.

Skills and Competencies:

  • Strong knowledge of FDA, NCQA, EQRO, and CMS regulatory guidelines.

  • Proficiency in Microsoft Office Suite (Outlook, Word, Excel, PowerPoint).

  • Demonstrated ability to work independently or as part of a collaborative team.

  • Excellent verbal and written communication skills.

  • Strong organizational, analytical, and multitasking abilities.

  • Competent in compendia navigation and pharmaceutical research tools.

  • Proven ability to manage multiple priorities effectively.

Additional Information

  • Candidates must be based in one of the 19 approved BCBST states.

  • All applicants will be notified that BlueCross, as a federal contractor, may be required to implement a COVID-19 vaccination mandate.

Nancy
Talent Acquisition | Nukasani Group Inc
Tel
Email:

540 W Galena Blvd, Suite 200, Aurora IL 60506.