Coverage Review Pharmacist

For our client, we are seeking a Coverage Review Pharmacist to join the team of a leader in the Healthcare space.

This remote role is focused on clinical coverage determinations and appeals within a healthcare insurance environment. The pharmacist will help ensure reviews are accurate, well-documented, and aligned with applicable regulatory and clinical standards. This position also serves as a clinical resource for colleagues handling straightforward to moderately complex review cases and supports compliant communication with members and providers.

Location: Remote - US based candidates only, no visa sponsorship available

Compensation: $100,000 – $120,000 annually

Responsibilities

• Perform prospective and retrospective coverage reviews and appeals in accordance with regulatory requirements
• Serve as a clinical resource for resolving basic to mid-level review cases
• Maintain denial rationale aligned with clinical criteria
• Ensure decision letters meet regulatory compliance requirements
• Participate in an alternating on-call team rotation

Qualifications

• Doctor of Pharmacy (PharmD) required
• 3 years of clinical experience required, or 1 year of residency and/or board certification
• Licensed in Tennessee or eligible for licensure within 120 days of employment
• Strong knowledge of regulatory guidelines, including FDA, NCQA, EQRO, and CMS
• Proficiency in Microsoft Office suite, including Outlook, Word, Excel, and PowerPoint
• Excellent oral and written communication skills
• Ability to work independently or as part of a team in a dynamic environment

Benefits

• Opportunity to work with a reputable company in the healthcare insurance field
• Engagement in a collaborative team environment
• Chance to enhance clinical skills and regulatory understanding
• Potential for career advancement within the organization

Our client is an equal opportunity employer. We encourage you to apply even if you don’t meet every qualification—your background could be exactly what this team needs.