Coverage Review Pharmacist

$67.48 per hour

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Chattanooga, TN

Coverage Review Pharmacist## ActalentChattanooga, TNContractor### BenefitsDental CoveragePaid Time OffHealth Insurance### Job Description**Pharmacist - Coverage Review (Remote)****Location:** Remote (Must reside within 2 hours of Chattanooga, TN)**Duration:** 3-Month Contract (1/18/2027 - 4/16/2027)**Schedule:** Monday-Friday, 8:00 AM - 5:00 PM ET (1-hour lunch)**Pay Rate:** $67.48/hour**Position Overview**We are seeking a Pharmacist to join a leading Tennessee health insurance provider in a fully remote role. This position is responsible for reviewing medication-related prior authorizations, pharmacy appeals, and member grievances while ensuring compliance with state and federal regulations. The ideal candidate will have prior coverage review experience, strong clinical judgment, and the ability to work independently in a fast-paced environment.**Key Responsibilities*** Review and evaluate medication prior authorization requests, pharmacy appeals, and member grievances.* Perform prospective and retrospective coverage reviews in accordance with state and federal regulations.* Respond to prescribers, pharmacy providers, and members regarding appeals, grievances, and pharmaceutical service determinations within established timelines.* Research and interpret clinical information using pharmaceutical compendia and evidence-based resources.* Build and maintain decision trees within the prior authorization system.* Maintain denial rationale documentation and ensure determination letters meet all regulatory requirements.* Collaborate with internal teams to support quality, compliance, and member service objectives.* Apply clinical criteria and guidelines to make appropriate coverage determinations.**Required Qualifications*** Licensed to practice Pharmacy in Tennessee, or eligible for Tennessee licensure.* Minimum of 3 years of clinical pharmacy experience, or completion of a 1-year residency and/or board certification.* Prior coverage review experience required.* Strong understanding of pharmacy prior authorizations, appeals, and utilization management processes.* Ability to work independently with minimal supervision and effectively within a team environment.* Experience navigating pharmaceutical compendia and conducting clinical research.* Proficiency with Microsoft Office applications, including Outlook, Word, and Excel.Why This Opportunity?* 100% Remote* Monday-Friday schedule, no weekends* Opportunity to work with a prominent Tennessee-based health insurance organization* Gain experience in managed care and pharmacy coverage review* Competitive pay at $67.48/hour**Work Environment:** Home-based role. Candidates must reside within 2 hours of Chattanooga, TN.Job Type & LocationThis is a Contract position based out of Chattanooga, TN.**Pay and Benefits**The pay range for this position is $67.48 - $67.48/hr.Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.Eligibility requirements apply to some benefits and may depend on your jobclassification and length of employment. Benefits are subject to change and may besubject to specific elections, plan, or program terms. If eligible, the benefitsavailable for this temporary role may include the following:Medical, dental & visionCritical Illness, Accident, and Hospital401(k) Retirement Plan Pre-tax and Roth post-tax contributions availableLife Insurance (Voluntary Life & AD&D for the employee and dependents)Short and long-term disabilityHealth Spending Account (HSA)Transportation benefitsEmployee Assistance ProgramTime Off/Leave (PTO, Vacation or Sick Leave)Job Type & LocationThis is a Contract position based out of Chattanooga, TN.Application DeadlineThis position is anticipated to close on Nov 24, 2026.Workplace TypeThis is a fully remote position.**About Actalent**Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 20,000 consultants and 5,000 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. We are proud to be an Engineering News-Record (ENR) Top 500 Design Firm for our engineering design services and a ClearlyRated Best of Staffing winner for both client and talent service.The company is an equal opportunity employer and will consider all applications withoutregard to race, sex, age, color, religion, national origin, veteran status, disability,sexual orientation, gender identity, genetic information or any characteristic protectedby law.If you would like to request a reasonable accommodation, such as the modification oradjustment of the job application process or interviewing process due to a disability,please email View email address on click.appcast.io for other accommodation options.**San Francisco Fair Chance Ordinance**Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in thecity and county of San Francisco, we will consider for employment qualified applicantswith arrest and conviction records.**Massachusetts Lie Detector**It is unlawful in Massachusetts to require or administer a lie detector test as acondition of employment or continued employment. An employer who violates this lawshall be subject to criminal penalties and civil liability.**Use of Artificial Intelligence (AI)**We may use Artificial Intelligence (AI) to support parts of our hiring process,including sourcing, screening, and evaluating candidates. AI helps assess applicationsand qualifications, but final decisions are made by our hiring team. By applying, youacknowledge and agree that your application may be reviewed using AI tools.You'll be redirected to apply on the company's website
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Vacancy posted 20 hours ago

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Coverage Review Pharmacist
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